Privacy and Forms

At Autumn Healthcare of Illinois, protecting the confidentiality of our patients is a very high priority. We invite you to view our privacy policies and other clinic information contained in the documents below.

Click Here to download a .pdf version of our Directions to fill out Forms.

Click Here to download a .pdf version of our Referral form. This form introduces you to our practice and some of the rules.

Click Here to download a .pdf version of our Notice of Privacy Practices. This form provides you with an overview of your rights as a client in our practice.

Click Here to download a .pdf version of our Autumn Healthcare Coordination Form .

Click Here to download a .pdf version of our Consent for treatment .

Click Here to download a .pdf version of our Autumn Healthcare Release of Information Form.