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Forms

For your convenience, you may print and complete several forms to expedite your check-in process on your initial visit. Please bring the completed forms with you on your initial visit or fax them to Barrington Rehabilitation at (847) 381-6311.

 

ALL PATIENTS:

 

ALL PATIENTS (choose one):

 

MEDICARE PATIENTS ONLY:

 

UNITED HEALTHCARE PATIENTS ONLY:

 

CIGNA PATIENTS ONLY:

 

PARKINSON'S LSVT PATIENTS ONLY:

 

COLLEGE STUDENTS/PATIENTS 18 YEARS OF AGE AND OLDER (not accompanied by parent):

 

HIPAA FORMS: