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Patient Forms

SECURE ONLINE FORMS:

  1. Medical History Form
     
  2. Informed Consent Form

PDF (for printing or Fax):

  1. Medical History Form (printable PDF form for faxing)*
     
  2. Informed Consent Form (printable PDF form for faxing)*

*If you need Acrobat PDF Reader to view or print these forms, it's availale for download HERE.

FAX FORMS TO 1-847-398-8360

If you need assistances with these form, please call us:
Toll-free: 1-888-251-2653
Local: 1-847-577-8854
e-mail: staff@northstarweightloss.com



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