Chicago Women's Health Center

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Downloadable Forms

You may mail forms to Chicago Women's Health Center, 1025 W. Sunnyside Ave, Suite 201, Chicago, IL 60640 or fax them to us at 773-935-7145. Download Adobe Acrobat Reader to view these forms.

  • Medical Records Request
  • Medical Records Request (Spanish)
  • Medical Records Release
  • Medical Records Release (Spanish)
  • Medical Records Release to Self
  • Medical Records Release to Self (Spanish)
  • Notice of Privacy Practices
  • Address: 1025 W. Sunnyside, Suite 201, Chicago, IL 60640
  • Hours: Open weekdays, 9AM-4PM, by appointment. Some evening and Saturday appointments available.
  • Phone: 773.935.6126 Fax: 773.935.7145
  • About Us
  • History
  • Women's Health Movement
  • Board of Directors
  • Best Paps In Town T-Shirts and More!
  • CWHC Annual Reports
  • Resources and Links
  • Downloadable Forms
  • FAQs
  • Changes to CWHC's Sliding Scale

©2019 Chicago Women's Health Center

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