Barbra S. Hanna, D.O.
Heather A. Cushing, M.D.
Patient Forms

Please click on each form image to download an Adobe Reader® file of the form. Print, fill out and return the forms at your first appointment. For returning patients, please fill out another Patient Registration Form if any of your personal or insurance information has changed and bring to your next appointment.

Communicate with us online
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Patient Registration

Patient Medical History

Authorization to Release Patient Information

If you don’t have Adobe Reader® on your computer,
please click here for a free download

Associates in Gynecology, Ltd.
1604 North Main Street  •  Wheaton, Illinois 60187
630-260-1818