Children and Teens Medical center

Algonquin 847-854-5900
Lake Barrington 847-382-8900
Lake in the Hills 224-569-4100
Schaumburg 847-895-2900
Billing Dept 847-895-2902

PATIENT PORTAL
General Information | New Patient Forms | Vaccines | Handouts | Medical Devices

RESOURCES/FORMS

Children & Teens Medical Center is taking an exciting step forward in providing your children with health care. We are now participating in an electronic Health Information Exchange, known as eEXH, in which important information about your child's care can now be electronically and securely shared between this practice and other Advocate physicians involved in your child's care. This allows us to better coordinate the care that your child may receive from a number of participating physicians.

Click here to access all eEHX forms.
Click here to download the OPT IN form.
Click here to download the OPT OUT form.
New Patient Forms

Please download and fill out ALL forms and sign where necessary.
For the New Patient Questionnaire, fill out one form per child.


New Patient Information
(PDF)
Office Financial Policies
(PDF)
Notice of Privacy Practices
(PDF)
New Patient Questionnaire Ages 0-2 (PDF)
New Patient Questionnaire Ages 3-21 (PDF)

Miscellanous Patient Forms
Meet the Practice (PDF)
Consent for Release of Medical Records
(PDF)
Consent for Release of Medical Records from Hospital (PDF)
Authorization to Release Patient Information(PDF)
Tuberculosis Exposure Questionnaire (PDF)
Asthma Control Test (PDF)