Promise Healthcare

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Promise Healthcare

Documents

Please fill out these documents and bring the completed forms with you to your first appointment. 

Adult New Patient Forms

Nuevo Paquette de Paciente

 ADULT New Patient Packet

Minor New Patient Forms

MINOR New Patient Packet

2023-Spanish-Minor-New-Patient-Packet

MINOR Consent for Treatment Form 2023

15-PromiseMinorConsentforTreatmentForm2023 (1)

Medical Release of Information Forms

Authorize to Release Protected Health Information

Autorizar la revelación de información

Autoriser la divulgation de renseignements protégés sur la santé

授权发布受保护的健康信息

 

Mental Health Release of Information Forms

Authorize to Release Behavioral Health Information

Autorizar la revelación de información de salud conductual

Autoriser la divulgation derenseignements protégés sur la santé

授权发布行为健康信息

 

Persons Involved in Care Forms

Who can Discuss your Medical Information

Quién puede discutir su información médica

Qui peut discuter de vos renseignements médicaux

哪些人员可以讨论您的医疗信息

Name Change Form

PATIENT NAME CHANGE OR UPDATE FORM
FORMULARIO DE CAMBIO O ACTUALIZACIÓN DE NOMBRE DEL PACIENTE

 

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Online Payments

Billing or Payment Questions? Call (833) 544-0184 if you have any questions about your bill.

Online Donations

Your support helps us deliver high-quality medical, behavioral health, and dental care to those who might otherwise go without.

Services

Health Center Services:

  • COVID  Testing
  • COVID Vaccinations
  • Primary Care
  • Walk-in Clinic
  • Prenatal Care
  • School Physicals
  • Sports Physicals
  • Psychiatry
  • Counseling
  • Women’s Health
  • Dental Care
  • Medication Assistance
  • Social Services
  • Lab Services
  • 24 Hour Nursing Service

Community Health Services:

  • Enrollment Services
    • Medicaid
    • Medicare
    • Marketplace
  • Education Assistance
  • Resource Assistance

Dental Services:

  • Extractions
  • Restorations
  • Cleanings
  • Full Exams
  • Dental Health Education
  • Limited Urgent Care

Locations

Frances Nelson Clinic
819 Bloomington Road
Champaign, IL 61820
Health Center
(217) 356-1558

Promise Healthcare at the Urbana School-Based Health Center
1002 South Race Street
Urbana, IL 61801
(217) 239-4220

Promise Healthcare on Neil Street         821 S. Neil Street
Champaign, IL 61820
Health Center
(217) 356-1558

Promise Healthcare on Kirby Avenue    919 W Kirby Ave                                    Champaign, IL 61820

Promise Healthcare Rantoul                   424  E  Wabash Avenue                                Rantoul, IL 61866

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