Skip to Main Content
Chestnut Health Systems is a proud partner of the Illinois Call4Calm Text Line Service. Text "TALK" TO 552020 (or "HABLAR") for Spanish. The Illinois Call4Calm Text Line is not a crisis hotline, but is a source of support for anyone experiencing stress and in need of a listening ear. We are here to serve you.
  • My Cart
  • Central Illinois Central IL 888.924.3786
  • Madison and St. Clair Counties & Metro East IL Metro East IL 618.877.4420

Chestnut Health Systems

Main Navigation

  • Contact Us
  • Search
  • EBTx Center
    • Treatments and Research
      • Treatments
        • Adolescent Community Reinforcement Approach (A-CRA)
        • Assertive Continuing Care (ACC)
        • Community Reinforcement Approach (CRA)
      • Cultural and Gender Relevance
      • Homeless and Street-Living Youth
      • Young Adults (ages 18-25)
      • Juvenile Justice
      • Co-Occurring Disorders
      • Dissemination and Implementation
    • Training and Certification
    • EBTx Locations
    • Resources
    • Testimonials
  • About Us
    • Accreditation and Affiliations
    • Board of Directors
    • Executive Leadership
    • Mission, Vision & Values
    • News and Media
      • Chestnut In The News
      • Media Inquiries
    • Our Logo Story
    • Strategic Plan
    • Contact Us
  • How We Can Help
    • Addiction Treatment
      • For Adolescents
      • For Adults
      • Gambling
      • Learn the Facts: Addiction
    • Mental Health
      • For Children and Youth
      • For Adults
      • Learn the Facts: Mental Health
    • Primary Care
    • Credit Counseling
    • Housing
    • Prevention
  • COVID-19 Testing and Vaccines
  • Fees and Payment
    • Paperwork and Forms
  • Locations
  • Employment
  • Lighthouse Institute
    • Bookstore
      • Books
      • CDs
      • Curricula
      • GAIN (Global Appraisal of Individual Needs)
      • Manuals
      • Monographs
    • GAIN Coordinating Center
    • Illinois Addiction Studies Archive
    • Institutional Review Board
    • Research Projects
    • Research Scientists
    • Staff Publications
    • Financial Conflict of Interest Policy
  • LI Bookstore
  • Chestnut Family Health Center
    • Services
      • Medical Services
        • Primary Care
        • Psychiatry
        • Lab and Pharmacy
        • Medication Assisted Treatment
      • Behavioral Health
      • COVID-19 Testing - McLean County
      • Health Care Coverage Enrollment
        • What We Offer
        • Important Links
    • Commitment and Approach to Care
    • For Patients
      • What is a Patient-Centered Medical Home
      • Making an Appointment
      • Payment
      • Paperwork and Forms
      • Online Patient Services
      • healow™ App
      • Your Medical Records/Information
    • Our Providers
    • Collaborators
    • What is a FQHC?
    • Data and Reports
  • Chestnut Family Health Center
  • For Patients

Forms and Paperwork

  • Consent to Treat - Illinois
  • Consent to Treat - Missouri
  • Disclosure Authorization - Illinois
  • Disclosure Authorization - Missouri
  • Financial Responsibility and Authorization
  • Patient Income Eligibility Exception Waiver Application
  • Patient Rights - Illinois
  • Patient Rights - Missouri
  • Privacy Practices - Illinois
  • Privacy Practices - Missouri

Sign Up For Our Newsletter

x
After
Hours
Care

After Hours Care

Our hours: Monday, Tuesday, Wednesday, Friday: 8 a.m. - 5 p.m. and Thursday: 8 a.m. - 7 p.m.

If you feel that you have a medical emergency, please call 911 or go to one of the local hospital Emergency Departments.*

If you are a current patient and need access to an on-call nurse during non-business hours, please call either the Chestnut Family Health Center main line in Bloomington, IL at (309) 557-1400 or in Granite City, IL at (618) 512-1919 and follow the prompts.

x
Our
Locations
and Services
Chestnut Family Health Center
  • Services
  • Commitment and Approach to Care
  • For Patients
    • What is a Patient-Centered Medical Home
      • Making an Appointment
        • Payment
          • Paperwork and Forms
            • Online Patient Services
              • healow™ App
                • Your Medical Records/Information
                • Our Providers
                • Collaborators
                • What is a FQHC?
                • Data and Reports

                This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

                This health center receives HHS funding and has federal Public Health Service deemed status with respect to certain health or health-related claims, including medical malpractice itself and its covered individuals.

                © Chestnut Health Systems Inc. All Rights Reserved.
                • Privacy Statement
                • Terms of Use
                • HRSA National Health Service Corps
                • Primary Care Medical Home Accreditation
                • The Joint Commission National Quality Approval
                • HRSA National Quality Leader