LifeSource Health and Wellness Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• Download the necessary forms, print it out and fill in the required information.
• Fax us your printed and completed forms to 630-690-4680 or bring it with you to your appointment.

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Forms
For children, please download the pediatric form below:

Download & Print Pediatric Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!