Chicago Women's Health Center

  • Donate
  • News & Events
    • News
    • Calendar
    • Sign up for our Newsletter

  • Get Involved
  • FAQ
  • Search
  • About Us
    • Historia
  • Services & Programs
    • Ginecología
    • Primary Care
    • Consejería
    • Inclusión de las personas trans: nuestro compromiso con la comunidad trans
    • Acupuntura
    • Extensión Comunitaria y Educación
    • Group & Workshop Schedule
  • Payment
  • Register
  • Find Us
  • English
  • /
  • Español

Downloadable Forms

You may mail forms to Chicago Women's Health Center, 1025 W. Sunnyside Ave, Suite 201, Chicago, IL 60640. 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
  • Dirección: 1025 W. Sunnyside, Suite 201, Chicago, IL 60640
  • Horas: Open daily, 9AM - 4PM, by appointment
  • Llámenos: 773.935.6126
  • Historia

©2018 Chicago Women's Health Center

  • Facebook
  • Twitter
  • Instagram