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Outpatient Behavioral Services Form

Thank you for choosing Palos Community Hospital for your Outpatient Behavioral Services. Our expert clinicians are dedicated to providing the finest in evidence-based services, tailored to meet your individual needs.

To help us provide you with the best possible, we ask that you complete the following form:

Registration Information Form


Please remember to bring this completed form with you to your first appointment. Or, consider faxing it to us ahead of time at (708) 226-2621.

If you have this form with you, you should plan to arrive 15 minutes before your scheduled appointment.

If you do not have this form with you and completed, please plan to arrive 45 minutes before your scheduled appointment to allow you time to complete the form.