Center for Health Services
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New Patient Form

CHS INTAKE APPLICATION FORM (pdf)

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Contact Us

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Please contact us directly with any questions, comments, or scheduling inquiries you may have. 


Fill out the new patient form above and send it to us via our contact form to save time when you come in for your appointment.

Center for Health Services

Tel (847) 893-9877 Fax (833) 412-2106

Hours

Monday - Friday: 9 AM–5 PM

Saturday as needed


Emergency Service: 24/7


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