Read about Dr. Bain's court cases and how he passionately fights for his patients!

Dr. ALan Bain, D.O.
  • WE'RE HERE FOR YOU!
  • THIS IS US!
  • SERVICES AND TREATMENT
    • Covid-19
    • Candida/Yeast Overgrowth
    • Thyroid Treatment/Therapy
    • Lyme Disease
  • Patient forms
  • SCHEDULE APPOINTMENT
  • PAY YOUR BILL
  • CONTACT US
  • More
    • WE'RE HERE FOR YOU!
    • THIS IS US!
    • SERVICES AND TREATMENT
      • Covid-19
      • Candida/Yeast Overgrowth
      • Thyroid Treatment/Therapy
      • Lyme Disease
    • Patient forms
    • SCHEDULE APPOINTMENT
    • PAY YOUR BILL
    • CONTACT US
Dr. ALan Bain, D.O.
  • WE'RE HERE FOR YOU!
  • THIS IS US!
  • SERVICES AND TREATMENT
    • Covid-19
    • Candida/Yeast Overgrowth
    • Thyroid Treatment/Therapy
    • Lyme Disease
  • Patient forms
  • SCHEDULE APPOINTMENT
  • PAY YOUR BILL
  • CONTACT US

REQUIRED PATIENT FORMS

Our practice requires all patients to have updated Patient Forms on file. 

Failure to have completed forms will result in rescheduling or cancellation of your appointment. 

Please call or message us if you have any questions. 

MEDICAL RECORDS MAY BE FAXED TO: 877-325-2058

REQUIRED MEDICAL CONSENT FORMS

REQUIRED MEDICAL CONSENT FORMS

REQUIRED MEDICAL CONSENT FORMS

All patients' (New and Established)  must have updated patient forms on file. Click to access our required patient forms. 

REQUIRED PAYMENT AGREEMENT

REQUIRED MEDICAL CONSENT FORMS

REQUIRED MEDICAL CONSENT FORMS

New to our practice or have recent changes to your insurance? Complete this form with your up to date insurance information and billing policy. Click to access payment agreement form.

RELEASE OF INFORMATION AUTHORIZATION

RELEASE OF INFORMATION AUTHORIZATION

RELEASE OF INFORMATION AUTHORIZATION

Patient's requesting our office to send their medical records to another party must complete a medical release of information authorization. Click to access medical release of information. 

FINANCIAL HARDSHIP WAIVER

RELEASE OF INFORMATION AUTHORIZATION

RELEASE OF INFORMATION AUTHORIZATION

Your health should never be put on hold due to financial difficulties. We offer affordable discounted rates based on each individuals circumstances. Please complete if you wish to be considered for a hardship waiver. You will be notified if you qualify for this waiver.

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Chicago Health And Wellness Alliance

8 S. Michigan Ave, 1403 Chicago, IL 60603

Ph 312-236-7010 Ext 2. | Fax 877-325-2058

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