New Patient - Health History Form

Please click on the PDF link below and download or print our "Health History Form".

Once completed you can FAX it to our office prior to your treatment at 708/562-1744 or bring the completed form into our office on your first visit. Any questions, please feel free to call us at 708/562-1234


Health History Form

AMERICARE Health & Rehab Center
1900 South Mannheim Rd.• Westchester, Il 60154
708/562-1234
amer4care@AOL.com