Prior to your first visit, please try to complete a record release form, so that we may receive your medical records.  To request a form via email, please complete the information below (your name, email address and message that you are requesting a record release form and then click SUBMIT).   After you receive the release form, fill it out and be sure to initial HIV/Mental/Alcohol lines, sign and date. Fax back to 773-857-2645 (preferable) or email us back with the completed release as an attachment .  We will copy your release and then forward the form to your previous practice location. THANKS.