Chicago Women's Health Center

Compassionate • Collaborative • Comprehensive

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Downloadable Forms

You may mail forms to CWHC or fax it at 773-935-7145. Download Adobe Acrobat Reader to view these forms.

  • Medical Records
  • Medical Records Release to Self Form
  • Medical Records Release/Request Form
  • Client Payment Agreement
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  • Women's Health Movement
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  • Address: 3435 N Sheffield Ave., Chicago, IL 60657 (map)
  • Hours: Open daily, 9AM - 4PM, by appointment
  • Phone: 773.935.6126 Fax: 773.935.7145

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Downloadable Forms

  • Medical History Form
  • Medical Records Release to Self Form
  • Medical Records Release/Request Form
  • Client Payment Agreement

©2013 Chicago Women's Health Center

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