Below are forms for new patients that can be downloaded and completed prior to your first appointment with us.

Patient Registration
CMG Patient Registration v2.pdf
Adobe Acrobat Document 156.9 KB
Medical History
Patient Medical History v2.pdf
Adobe Acrobat Document 193.8 KB

NICHQ Vanderbilt Assessments are used by our providers to help diagnose and monitor patients with ADHD.

Vanderbilt Initial Assessment Questionnaires
Vanderbilt Initial Assessment Parent & T
Adobe Acrobat Document 788.7 KB
Vanderbilt Follow-up Assessment Questionnaires
Vanderbilt Follow-up Assessment Parent &
Adobe Acrobat Document 498.2 KB

A request for release of medical records must be completed and signed before medical records can be transferred.  Below are forms for both requesting records from a previous medical provider to be mailed to our office, as well as a form authorizing CMG to provide your child's medical record to a third party.

Release of Medical Records to CMG
HIPAA Release to CMG.pdf
Adobe Acrobat Document 203.2 KB
Release of Medical Records from CMG
HIPAA Release From CMG.pdf
Adobe Acrobat Document 173.1 KB

P: 847-658-6065

F: 847-658-6136


301 N Randall Rd

Lake in the Hills, IL 60156

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Masks will be required in our office should McHenry County COVID community levels become HIGH





Open Letter to Parents
VPS 1.1.16.pdf
Adobe Acrobat Document 136.6 KB


Required Vaccines for IL Schools
IL immunization reqirements 2021.pdf
Adobe Acrobat Document 171.3 KB