Client Request Form
Please review our detailed eligibility guidelines to see if you qualify for our services. If you are in need of assistance, please fill out our Application Form. The information we request will better enable us to determine if our clinic can provide you with meaningful assistance.
Once we have received the information we will attempt to schedule a meeting with you as soon as possible thereafter. All clients are required to attend a meeting in our clinic office location.
If you have any questions, please call the Clinic office at 312-915-7176.
Documents can be faxed to us at 312-915-7837.