2615 W Harrison

Bellwood, IL 60104

Phone:  708-493-9500

Fax:  708-493-9574

For your convenience, please feel free to download and complete each of the forms below before your scheduled appointment. 

Document Library

NameDescription
DocumentAthletic Imaging Benefits AgreementBenefits Agreement
DocumentAthletic Imaging Patient HistoryPatient History
DocumentAthletic Imaging Patient InformationPatient Information
DocumentAthletic Imaging Privacy PolicyHIPAA Signature Page
DocumentAthletic Imaging Privacy Policy TermsHIPAA Document
DocumentSpanish Benefit AgreementSpanish Benefit Agreement
DocumentSpanish HistorySpanish History
DocumentSpanish Patient InfoSpanish Patient Info
DocumentSpanish HIPAASpanish HIPAA
DocumentSpanish HIPAA StatementSpanish HIPAA Statement