Demo Site • Do Not Update
Skip to Main Content
Chestnut Health Systems is a proud partner of the Illinois Call4Calm Text Line Service. Text "TALK" TO 552020 (or "HABLAR") for Spanish. The Illinois Call4Calm Text Line is not a crisis hotline, but is a source of support for anyone experiencing stress and in need of a listening ear. We are here to serve you.
  • My Cart
  • Sign Up for Newsletter
  • 888.924.3786
  • Madison and St. Clair Counties & Metro East IL Metro East IL618.877.4420

Chestnut Health Systems

Main Navigation

  • Contact Us
  • Search
  • About Us
    • Mission, Vision & Values
    • Board of Directors
    • Executive Leadership
    • Statement of Strategic Direction
    • Our Logo Story
    • Accreditation and Affiliations
    • Contact Us
    • News and Media
      • For the Media
      • Chestnut In The News
    • Safe With Chestnut
  • Services (How we can help)
    • Addiction Treatment
      • For Adolescents
      • For Adults
      • Gambling
        • Resources
      • Learn the Facts-Addiction
    • Mental Health
      • For Children and Youth
      • For Adults
      • Learn the Facts-Mental Health
    • Primary Care
    • Credit Counseling
    • Housing
    • Prevention
    • Chestnut Family Health Center
      • Our Providers
      • Data and Reports
      • Collaborators
      • What is a FQHC?
      • Commitment and Approach to Care
      • Services
        • Medical Services
        • Behavioral Health
        • Health Care Coverage Enrollment
      • For Patients
        • What is a Patient-Centered Medical Home
        • Making an Appointment
        • Payment
        • Paperwork and Forms
        • Online Patient Services
        • healow™ App
        • Your Medical Records/Information
      • Quick Links
  • Lighthouse Institute
    • Bookstore
      • Books
      • CDs
      • Curricula
      • GAIN (Global Appraisal of Individual Needs)
      • Manuals
      • Monographs
    • Research Scientists
    • Research Projects
    • Staff Publications
    • Illinois Addiction Studies Archive
    • Project Combine
    • Institutional Review Board
    • GAIN Coordinating Center
  • LI Bookstore
  • Fees and Payment
  • Locations
  • Employment
  • Events
  • EBTx Center
    • About Us
      • EBTx Locations
    • Treatments and Research
      • Treatments
        • Adolescent Community Reinforcement Approach (A-CRA)
        • Assertive Continuing Care (ACC)
        • Community Reinforcement Approach (CRA)
      • Cultural and Gender Relevance
      • Homeless and Street-Living Youth
      • Young Adults (ages 18-25)
      • Juvenile Justice
      • Co-Occurring Disorders
      • Dissemination and Implementation
    • Training and Certification
    • Resources
    • Testimonials
  • Chestnut Family Health
  • Services (How we can help)
  • Chestnut Family Health Center
  • For Patients

Paperwork and Forms

  • Consent to Treat - Illinois
  • Consent to Treat - Missouri
  • Disclosure Authorization - Illinois
  • Disclosure Authorization - Missouri
  • Financial Responsibility and Authorization
  • Patient Income Eligibility Exception Waiver Application
  • Patient Rights - Illinois
  • Patient Rights - Missouri
  • Privacy Practices - Illinois
  • Privacy Practices - Missouri

Sign Up For Our Newsletter

x
Get
Help
Now

Get Help Now

If you or someone you know is in an emotional crisis or thinking about suicide:

Use our contact form or call 888.924.3786.

For Madison and St. Clair Counties and for the Metro East area, call 618.877.4420.

National Suicide Prevention Lifeline — 1.800.273.8255.

If you know someone who is in an immediate risk of hurting himself or others, call 911.


x
Our
Locations
and Services
Services (How we can help)
  • Addiction Treatment
  • Mental Health
  • Primary Care
  • Credit Counseling
  • Housing
  • Prevention
  • Chestnut Family Health Center
    • Our Providers
      • Collaborators
        • Data and Reports
          • What is a FQHC?
            • Commitment and Approach to Care
              • Services
                • Medical Services
                • Behavioral Health
                • Health Care Coverage Enrollment
              • For Patients
                • What is a Patient-Centered Medical Home
                • Making an Appointment
                • Payment
                • Paperwork and Forms
                • Online Patient Services
                • healow™ App
                • Your Medical Records/Information
              • Quick Links
              © Chestnut Health Systems Inc. All Rights Reserved.
              • Privacy Statement
              • Terms of Use