New Patient Forms - Integrated Health of Southern Illinois

We know that your time is valuable. That’s why we do everything we can to make sure your visit to Integrated Health of Southern Illinois goes smoothly. One way to streamline the process for new patients is for you to go ahead and complete a few forms that are necessary. We’re going to ask you to fill out these forms anyway, why not do them in the comfort of your own home (as opposed to the comfort of our fabulous reception area)?

New Patient Forms

1. New Patient Registration Form (PDF)
2. Lien (PDF)
3. IH Privacy Policy (PDF)
4. IH Privacy Policy Receipt (PDF)
5. Consent to Treat Minors (PDF) *if applicable

1. New Patient Registration Form (PDF)
2. Lien (PDF)
3. IH Privacy Policy (PDF)
4. IH Privacy Policy Receipt (PDF)
5. Injury Report (PDF)
6. Consent to Treat Minors (PDF) *if applicable

Nutrition Patient Forms

1. New Patient Registration Form (PDF)
2. IH Privacy Policy (PDF)
3. IH Privacy Policy Receipt (PDF)
4. Male History Questionnaire (PDF)
5. Female History Questionnaire (PDF)
6. Youth History Questionnaire (PDF)