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DREYER PATIENT RESOURCES

Dreyer Patient Resources

Online Resources

E-Statement (dreyermed.com/estatement)	View and pay your bill online
MyChart (dreyermed.com/mychart)
Patient Advocacy Team (dreyermed.com/quality)	Submit feedback regarding care or services (For billing issues please contact the Business Office.)

Forms (Please print and bring a copy to our office)

Authorization for Treatment of Minors - English
Authorization for Treatment of Minors - Spanish
Change of Primary Care Physician	BCBS
Coordination of Benefits
Forms Completion Authorization
Forms Completion Authorization - Spanish
Medical Records Request Form - English	(For Psychiatry records, please contact the Psychiatry Department at 630-906-5120.)
Medical Records Request Form - Spanish
Patient Demographic Form - English
Patient Demographic Form - Spanish
Patient Registration - English	Please print out, complete, and bring to our office.
Patient Registration - Spanish
Verbal Disclosure - English	Authorizes Dreyer to discuss your health information with a designated family member or representative in person or over the phone.
Verbal Disclosure - Spanish

Information

2012 Patient Handbook
2012 Patient Handbook - Spanish
Advance Directives Booklet, "A Personal Decision"	(Provided by the Illinois State Medical Society.)
Financial Resources
Notice of Privacy Practices
Patient Rights and Responsibilities
Preventive Screenings
Utilization Management

News

Dreyer Welcomes New Family Medicine Physician

Mansi Sheth, D.O., has joined the Department of Family Medicine at Dreyer Medical Clinic’s Oswego location. Dr. Sheth received her undergraduate degree from the University of Illinois at Urbana-Champaign in 2004.

Dreyer Medical Clinic - 11 service locations in 6 Fox Valley area communities