36735 N. Highway 83Lake Villa, IL 60046ph: 847-265-5600fax: 847-245-4491info@RLBmedicalcenter.com
Click on the yellow lettered links to print your forms!
Personal Health History Form
Consent to be treated in our office, Please Read and Sign.
Privacy Agreement, Please Read and Sign.
Pain Rating, Dr. Reiser would like to know where your pain is during certain activities. If it doesn't apply to you please leave it blank. Sign at the top of the page.
Insurance and Financial Procedures, Please initial on the blank lines that you've read each line and sign at the bottom.