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New Patient Forms

 

 


We want your first visit to Dr. Kedainis to be as stress free as possible. For your convenience, we’ve placed our new-patient forms on our Web site so you can download them, print them off and fill them out at home at your leisure.

Please click on the “Patient Record of Disclosures,” “Patient Information” and “Agreement” forms below to open them. They are provided in Adobe Acrobat PDF format. If you do not have Adobe Acrobat Reader on your computer, you can click on the Adobe Acrobat logo below to download a free version. Once you have downloaded Adobe Acrobat Reader, you will be able to open the new-patient forms.

 

Fill the forms out at your leisure and bring them with you when you come for your first visit.

Patient Record of Disclosures

Patient Information

Agreement

You can download a free copy of the Adobe Acrobat Reader here.

 

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Lockport Crossings Outpatient Center
1206 East 9th (159th) Street Suite 210
Lockport IL 60441
Office tel. (815) 834 8777
Office fax (815) 834 1302
©2009. Dalius Kedainis, MD.
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