If directed, fill out the appropriate form(s) and fax to 630.654.5345, or drop them off at our main location in Hinsdale, Illinois. To ensure confidentiality, email is not an appropriate method for returning forms to us.
For Participants
- Participant Form (English) | Formulario de Informacion del Participante (Español)
- Patient Referral Form (for Healthcare Providers)
- Cancer Survivor Health History
- Caregiver Health History (PDF)
- Informed Consent Waiver (PDF) | Informe Al Participante De Consentimiento O Renuncia (Español PDF)
- Medical Release Form (PDF)
- Mile Square Health Center Medical Release Letter (PDF) | Mile Square Health Center Medical Release (PDF)
- Liberacion Medica (Español PDF)
- Wellness House Bereavement Form
For Volunteers
- Volunteer Application Form (Adult)
- Volunteer Application Form (Teen)
