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