• Submit an electronic request by selecting Request Appointment, then Request Online in the main menu above; or,
  • Call 1-877-692-8686 to speak to one of our customer service representatives.
  • Sliding Fee is available
  • Co-pays due on service date
  • Minimal nominal fee is due

Please bring the following items and/or information to your appointment:

  • Past medical history
  • Current medications
  • Pharmacy information
  • Picture ID
  • Insurance card
  • Immunization records (if available)
  • Proof of guardianship
  • Contact information for your DCFS worker (if applicable)
  • Proof of income (if currently uninsured)

We highly encourage that patients make appointments prior to arriving at the clinic.

However, if you chose to walk in without an appointment, you will be evaluated by the clinic staff and based on the symptoms presented one of the following may occur:

  • Will be seen today (which may include a variable wait time)
  • Offered to make an appointment for a different date/time
  • Referred to the Emergency Room

The steps involved depend on what records you want provided and/or for whom you want your records provided to.

In most cases, you will need to download and submit the following documents, which are available in our Patient Information Center:

  • Acknowledgement of Medical Record Request Processing Fee / Reconocimiento del cargo por procesamiento de la solicitud de registros médicos
  • Request and Authorization to Release Health Information / Peticion Y Autorizacion Para Liberacion Y Uso De Informacion Medica

Signed and completed authorization forms may be submitted in person, by fax or by mail:

In Person
Drop off the form at one of Aunt Martha’s Health Centers

By Fax (with copy of ID)

By Mail
Aunt Martha’s Youth Service Center
ATTN: Medical Records
19990 Governors Hwy
Olympia Fields, IL 60461

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