Downloadable Forms

Click the link to download 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

You can email forms to: medicalrecords@chicagowomenshealthcenter.org (please know, email is not a completely secure form of communication)

You can mail forms to: CWHC 1025 W. Sunnyside Ave, Suite 201, Chicago, IL 60640

You can fax forms to: 773-935-7145