Below is A list of Practice Documents and Instructions for a given situation.

Pre-appointment documents: If this is your first time seeing one of our providers at this location, you can expedite the process by providing the documents below. Feel free to upload any relevant information to your ZocDoc profile, fax it to us at 773-832-8701, or email FrontDesk@GilleonHealth.com

• Copy of your Insurance card.

• A signed copy of our Patient Consent Form. Click on the link below to download the form.

  • Patient Consent, Billing Address, and Pharmacy info

• Your preferred pharmacy information. There is a space for this on the bottom of the Patient Consent Form described above.

• Medical records from a previous practice. Click on the appropriate link below to download a pre-populated release form that you can send to your previous practice to request a copy.

  • Record Release from any practice

Cancelation and No-show policy: If you are unable to make an appointment please reach out to the front desk to cancel/reschedule either by phone at 773-832-8700 or, email FrontDesk@GilleonHealth.com within 24 hours of your scheduled appointment. Our system does not send reminders unless you book on ZocDoc.com so please make note of your appointment when scheduling. If you do not cancel/reschedule within 24 hours of your appointment time or if you no-Show an appointment it will result in a $30 fee being charged. If you have 3 or more No-Shows it could result in termination as a patient.

Balances Due: You can pay balances due on the patient portal or by reaching out to the office directly to pay by phone. Self pay balances are due in full the day of your appointment. Balances billed to insurance that still have remaining balances due after billing insurance for deductibles/co-insurance are due 10 days from the statement date in relation to that visit. Balances older than 120 days are subject to collection and may prevent you ability to book future appointments.