Forms

Call OPCS Now (708) 403-8500

To ensure your visit runs as smoothly as possible, you are encouraged to print out and complete the necessary forms at your convenience before your appointment time.

Please bring your forms with you to your appointment or fax to (708) 364-7080

New Patient Forms

For New Pediatric Patients:
Pediatric Registration Packet

For New Internal Medicine Patients:
Adult Registration Packet

To Sign Up for Patient Portal
Patient Portal Consent Form

To Update your Personal or Insurance Information
Change of Information

Additional Forms
ICare Privacy Statement
ICare Opt Out Form
Advocate HMO Registration Form
Southland Registration Form
Notice of Privacy Practices
Medical Records Release Form
Patient Privacy Directive
Financial Policy Agreement
Power of Attorney for Health Care
Medicare Wellness Questionnaire

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