PCJ Patient Registration Form
The patient registration form will have to be filled out prior to or upon arriving at your appointment. Please arrive at least 15 minutes early to fill out the patient registration form, or print and fill out the patient registration form here and bring it with you.
PCJ Patient Survey Form
Please complete the patient survey after your appointment to inform us of your patient experience and how we are meeting your needs.
PCJ Patient Testimonial Consent Form
If you are interested in submitting a patient testimonial for Primary Care Joliet, please fill out the patient testimonial consent form. Please share your experience to help us serve you better. Let us know how you feel about our providers and staff, your overall experience, improvements in your health, etc.