New Patient Forms

We are required to provide you with forms to fill out and give to us before we begin your treatments. If you have any questions about these forms please call us at 773-885-1819.

WME HIPAA Notice of Privacy Practices Download PDF 
This HIPAA Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operation (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.

WME New Patient Form Download PDF
 This New Patient form provides us with important information and background on your medical condition and history.

WME Informed Consent Download PDF 
This Informed Consent form provides us with your consent to go forward with our treatment for you. It also covers your authorization to release records, notice of privacy practices, and consent to treat a minor child.

Make an Appointment

To make an appointment or inquire about a concern, call 773-885-1819, or fill out and submit a Response Form.
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How To Thrive In The Modern World: A Layperson’s Guide To Chinese Medicine





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