A Partnership to Support Student Health & Wellbeing

Event Details

Date: Aug 6th

Time: 10:00 AM – 3:00 PM

Location: 6374 N Lincoln Ave, Chicago, IL

What to Expect

• 1-Hour Wellness Visits

• Speak directly with MRHC Behavioral Health team

• Get questions answered about our services and providers

• Learn about our Primary Care and Behavioral Health services

• MRHC welcomes all patients, regardless of whether or not you have insurance, your ability to pay or your immigration status.

How to Participate

Step 1: Complete this Registration Form

Step 2: After you submit the Registration form, a member of our staff will contact you to schedule your appointment

Step 3: Once your appointment is scheduled, please complete the following forms in advance to help expedite the check-in process. You may either print the forms, fill them out and bring them with you on the day of your appointment date or send them to us digitally via email at info@midwestrefuah.org

1. Patient Registration Form
2. Consent to Treat Minor & Designated Surrogate Form
3. Release of Information Form
4. Family or Friend Consent Form
5. Sliding Fee Scale Info Sheet
6. Sliding Fee Scale Application Form

How to Prepare for your Visit

1. Please arrive 15 minutes before your scheduled appointment.

2. If you are applying for the sliding fee program, all forms and supporting documents MUST be submitted at least  48 hours prior to your scheduled appointment. 

3. If you have insurance, please bring the following information to your appointment:

• Picture ID
• Insurance card
• Any relevant medical history (such as previous medical records, copies of immunizations, or list of current medications)

4. We accept most insurances including Medicaid and Blue Cross Blue Shield HMO 447.