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  • Patient Guide
    • New Patients
    • First Visit
    • Health Insurance
    • Insurance/Medicaid Help Sessions
    • Drug Pricing Program
    • Telehealth
    • Medical Records
  • Health Clinic
    • Family Practice Clinic
      • Women’s Health
      • Men’s Health
      • Sexual Health Education
      • Children’s Well-Being
    • Immunizations
      • Flu Vaccinations
    • 340B Pharmacy Program
    • COVID-19
      • Testing Schedule
      • Symptoms & Advice
      • Public Assistance
    • HIV Awareness & Testing
    • Diabetes Program
    • Local Dental Providers
  • Behavioral Health
    • Therapy & Counseling
    • Talking Circles Peer Support Groups
    • Behavioral Health Meetings
    • Domestic Violence Prevention Program
    • Suicide Prevention Program
    • Alcohol and Substance Use Disorder
  • Events
    • FULL EVENT CALENDAR
    • Every Child Matter Powwow
    • Sacred Strength: Women’s Event and Swap
    • Two-Spirit Talking Circle
    • 2025 AIHSC GALA
    • Senior Socials
    • Senior Luncheons
    • Sewing and Beading Circle
    • Drumming and Singing Practices
    • AA Meetings
    • Powwows
  • About
    • Donate
    • About AIHSC
    • Hours and Location
    • Team
    • Health News
  • 2025 GALA
  • Contact Us

View or download the forms.

Authorization for Use or Disclosure of Health Information

Consent to Treatment

Behavioral Health Consent Form

HIPAA Form

New Patient Form

Notice of Privacy Practices

Patient Bill of Rights

Patient Service Agreement

Release of Information

 

  • American Indian Health Service of Chicago, Inc.
  • E4326 W Montrose Ave Chicago, IL 60641
  • Phone: (773) 883-9100
  • Fax: (773) 883-0005
  • Clinic Hours
  • Monday-Friday: 8:00am-4:30pm
  • Privacy Policy
  • Patient Bill of Rights
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© 2025 American Indian Health Service of Chicago, Inc.