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First Health Associates offers online forms for your convenience.  The list below includes all necessary new patient forms, and program and lecture registration forms that can be completed in the convenience of your  home or office.

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  • Download the necessary form(s), print them out and fill in the required information.
  • Fax us your completed form(s) or bring them with you to your appointment.   Fax: 847-593-3346

New Patient Forms
Please complete the first 4 forms plus the intake forms listed under the type of provider you will be seeing.  If you cannot complete the forms prior to your visit, please arrive 30 minutes before your scheduled new patient appointment to complete them in our office. 

Medical History
Patient Demographics
Consent Forms
Office Financial Policy

* Additional Provider Specialty Intake Forms

Physical Medicine & Rehab
     New problem Intake
     New Problem Intake

     Follow up Re-exam
     Neck or Back Functional Rating
     Lower Extremity Functional Rating
     Upper Extremity Functional Rating
Behavioral Health
     Self-Reporting Check List
     Informed consents - required

Traditional Chinese Medicine
     TCM Patient History
     Nutrition Intake
     3 day Food Log


Program Forms
       Coming Soon

Lecture Registration Forms
      Coming Soon