To expedite your registration process, all required forms that need to be read and signed are provided below in PDF format that can be downloaded.  Simply click on the links.  Please read the Notice of Privacy Practices and download the Patient Registration form by clicking on the link and complete it and bring it to your visit.  Please do not hesitate to call us at (630) 513-9160 for any questions.  Thank you.

For pediatric patients only, to provide treatment for your children, TLC Medical Group will require a signed consent from the guardian.  Please click and download the Authorization to Treat Form and provide us with a signed copy.

Is your child receiving a vaccine?  Please follow this link to view or print a copy of the Vaccine Information Statement.

To facilitate the efficiency of your scheduled visits, the required forms that need to be filled out at age-appropriate visits are available for download by clicking below.  It is highly recommended to have these forms filled out in the comfort of your homes.  Please bring them with you at your child(ren)'s visit(s).  Please call us if you have any questions.  Thank you. 

Forms and Registration

In order to better serve ill patients who were asked to wait for availability, there will be a $25 charge for cancellations made without a prior 24 hour notice.  We appreciate your cooperation.  Thank you.

TLC Medical Group, S.C.

For new patients who are transferring their care to TLC Medical Group, or for patients moving or transferring their care, please click on the appropriate link below and download the medical release authorization forms and complete them.  Your signed release form is what you need to submit to your previous doctor(s) so that we can promptly receive your records.  Your signed release form will also provide us the authorization to send or release your confidential records to your new physician.  It is the patient's responsibility to follow through to make sure the records are sent to TLC Medical Group.  Thank you.  Please call us if you require assistance with this process.

Call Us: (630) 513-9160