Forms

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
CMG Patient Medical History v2.pdf
Adobe Acrobat Document 173.7 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 308.4 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 99.1 KB
Release of Medical Records from CMG
HIPAA Release From CMG.pdf
Adobe Acrobat Document 188.1 KB

P: 847-658-6065

F: 847-658-6136

 

301 N Randall Rd

Lake in the Hills, IL 60156

 

** WE HAVE MOVED **

On February 1st, 2016, we began seeing patients at our new location.   Google Maps

 

 PATIENT PORTAL

 

 *** BULLETINS ***

 

CMG VACCINATION POLICY STATEMENT

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

IL VACCINATION REQUIREMENTS

Required Vaccines for IL Schools
MinImmzReq.pdf
Adobe Acrobat Document 180.9 KB

2017-2018 FLU VACCINE CLINICS

 

Clinic Schedule

 

AAP GUIDELINES

 

New AAP Guidelines