Now accepting new patients · Chicago clinic, telehealth & in‑home care

(312) 796-2646

Patient forms

Confidential screenings, done before you arrive.

Answer a short, validated questionnaire and send it securely to your provider ahead of your visit. Most take two to five minutes.

A-Nu Health is not an emergency service.

If you are experiencing a medical emergency, call 911. If you are experiencing a mental health crisis, call or text 988. Do not submit urgent medical information through website forms.

Weight Management

Weight Management forms

Men's Health

Men's Health forms

Mental Health

Mental Health forms

Safety

If you are struggling right now

A note on privacy and limits. These forms support clinical care — they are not a diagnosis or a treatment plan. Submissions are reviewed by A-Nu Health staff during business hours and are not monitored continuously. If you are in crisis, call or text 988 or call 911.