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Click here when you are ready to complete your health history. This form will take 5-15 minutes to complete.
Please do not include your name anywhere on this form. We have provided you with your patient number via text.
If you have questions or prefer to give us your medical information via phone please call 312-707-8988.
BEFORE YOUR VISIT:
BEFORE YOUR VISIT:
FPA has partnered with My-IUD.com to provide Mirena and Paragard IUDs for our patients, after an abortion procedure. If you are scheduled for an abortion and are interested in an IUD, please call us at 312-707-8988 and ask us to create a referral for you. My-IUD.com will contact you directly to get you preauthorized. My-IUD.com is unable to do authorizations on the same day as your visit. You must be preauthorized before your visit for this service. My-IUD.com has contracts with most private insurance companies, Illinois Medicaid, and Medicaid programs in many other states as well.
The entrance to our Desplaines office is at the corner of Warren and Desplaines. If you are at 659 West Washington Blvd, Chicago, IL 60661, walk to the corner of Washington and Desplaines and turn right. Walk south on Desplaines, past the restaurant and gold doors, to the next corner. Look for a FPA sign on the sidewalk. The entrance is on the right.
Please call us at 312-707-8988 if you have any questions or need assistance entering the office.