new patient forms

Welcome to Therapy Services at Advocate Lutheran General Hospital's Parkside Facility!  In order to help your registration process go more smoothly, please download the forms below, complete at home, and then bring the completed forms with you on your first visit.  If you have any specific questions about the forms, we can answer them for you on your first day.

If you will be seeing a Physical or Occupational Therapist, please download and complete the following forms:

• The Authorization for Release of Patient Health Information
• Patient History and Intake Form for Physical Therapy/Occupational Therapy
• Missed Appointment policy

If you will be seeing a Speech Pathologist, please download and complete the following forms:

• The Authorization for Release of Patient Health Information
• Patient History and Intake Form for Speech Therapy
• Speech Medical Intake Form
• Missed Appointment policy

If you will be seeing an Audiologist, please download and complete the following forms:

• The Authorization for Release of Patient Health Information
• Patient History and Intake Form for Audiology
• Dizziness Questionnaire
• If you have been scheduled for a Videonystagmography or VNG (ENG) test, please click here for additional information regarding the test.