Downloadable patient registration forms.
Complete your medical history and registration documents before your visit so your appointment can focus on your care.
Approved Patient Registration Documents
Please download, print, and complete the official documentation matching your clinical appointment:
Adult Patient Registration Packet
Official 21-Page Registration & Medical History (PDF)For new adult patients. Includes personal background, insurance information, psychiatric history, symptom review, and practice financial policies.
Minor Consent to Treatment Form
Official 3-Page Minor Consent Form (PDF)For patients who are minors. Covers parent or guardian information, legal custody status, and consent to psychiatric evaluation, treatment, and medication.
Patient Records Request Form
Official 1-Page Records Transfer Request (PDF)Authorize outside psychiatric hospitals, therapists, or primary care physicians to transfer prior medical records directly to Premier Psychiatry.
Consent to Exchange Information (ROI)
Official 1-Page Release of Information Form (PDF)Authorize Premier Psychiatry to communicate with specific healthcare providers, family members, or emergency contacts regarding your care.
Review our Notice of Privacy Practices, which describes how medical information about you may be used and disclosed and how you can get access to this information.
Download Notice of Privacy Practices (PDF) →The adult intake packet includes a telehealth consent. Ask our office how to complete your forms if your visit will be virtual.
Open CureMD Patient PortalHow to Submit Your Completed Forms
Ask our office which of these options to use:
Ask our office whether completed forms can be uploaded through the CureMD patient portal.
Fax completed forms to (708) 799-1305.
Bring printed copies with you to your appointment in Orland Park or Willowbrook.