Dear Patient,

Thank you for your interest in The Healing Clinic! We appreciate your business.

The Healing Clinic LLC, is Chicago’s leading patient advocacy center for providing patients who qualify, with a certification for a “Medical Cannabis Registration Card”.

The Illinois Compassionate Use of Medical Cannabis Act, allows patients who have a “Qualifying Medical Condition” to seek certification by a licensed physician with who is also treating them. Under Illinois Law, registered cannabis patients can legally use, possess, and purchase medical cannabis from one of 60 state licensed dispensaries.

Unfortunately, our services are not covered by health insurance, Medicaid or Medicare at this time.

Payment will be collected at the time of your visits. We require two office visits with your THC- Integrative Primary Care Physician, who will certify you to use medical cannabis. This is to establish the state required bonafide patient/ physician relationship. Your assigned THC-Integrative Primary Care Physician will submit a “Physician’s Written Certification Form” to the Illinois Department of Public Health should they believe, after a thorough review of medical records related to your qualifying condition and conducting multiple in person physical exams, that you are a good candidate for medical cannabis. Certification for medical cannabis occurs after your second doctor’s visit. Renewal applications are required by the state every three years. The Healing Clinic will gladly handle that process. Our certifying physicians require medical cannabis patients to return annually for a physical examination.

* A fee of $150. 00 is due at your first visit/Wellness Physical Examination

* A fee of $150. 00 is due at your second visit/Integrative Care Plan + Cannabis Certification

Cancellation Policy: There will be a $50 charge for appointments cancelled within 24 hours of your scheduled visit.

We accept Visa, Discover, Mastercard, American Express, and Cash Payments.

*Please note that there are additional fees associated with medical cannabis registration. Ask one of our advocates or visit MCPP.illinois.gov for more information on the state’s application requirements.

Again, we appreciate you choosing The Healing Clinic for your integrative medical needs. If you have further questions, please call or write to us! We are always here for you and happy to help.

The Healing Clinic, LLC
312-890-6113
info@thehealingclinic.org

Patient Packet Form

New Patient Instructions:

• Please collect your medical records before your second visit at The Healing Clinic. The records must be current, meaning from within the past year. We only accept qualifying patients who have been diagnosed or treated with their debilitating condition(s) within the past 12 months.
• Fill out the New Patient Information form completely and accurately. You may submit these forms online and they will be emailed directly to us.
• Once your assigned THC-Primary Care Physician receives your medical records and information, one of our Patient Advocates will review your packet and contact you to schedule your first visit, or to request additional information if needed.
• Please review our Client HIPAA Rights form carefully and print a copy for your personal records.

Form Download

New qualifying patients can start by downloading the PDF document below. Fill in the packet details as outlined above, and submit to info@thehealingclinic.org. You will need Adobe Reader to either complete or view your packet document. Your packet can be completed in one of two ways, however with whichever option you choose, you must actually download the PDF to your computer AND save the document before you start filling it out and then send it in.

1. Fill Out Form On Your Computer: Download the document below, then complete the fields in the PDF form document. After you save your document, please send via email by emailing it as an attachment.
2. Plain Text PDF: Print off the PDF document below, fill by hand, scan and then submit as an attachment to the email listed in the document or by the fax number listed above.

THC Patient Packet Form: Complete and send by fax or attachment by email