
Forms
Please read and/or complete the following forms and return them before your initial visit.
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Office Policies (read-only)
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HIPAA Illinois Notice Form (read-only)
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Signature Pages: Consent for Assessment, Communication, HIPAA, Release of Information Forms for School, Pediatrician, and Referring Clinician: Children 12 and older should also sign these forms. If parents are divorced, both parents should complete these forms.
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Credit Card Information: To access all fields, the document must first be saved and opened from the saved file.
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Family History Form (to be completed by family)
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Release of Information (general): Please complete this form if you would like Dr. Edidin to communicate with other individuals involved in your (patients over 18 years old) or your child’s care (patients under 18 years old). Children 12 and older should also sign this form.