Please click on the form icons below to open an Adobe Reader® file of that form. Print and complete the Patient Information form and bring it to your next appointment.

If you don’t have Adobe Reader on your computer, click the icon at right for a free download. get adobe reader

Information Sheet
Notice of
Privacy Practices

Joseph L. Kut, MS, MD
3800 N. Wilke Rd., Suite 160  •  Arlington Heights, Illinois 60004  •  847-686-5700

AMITA locations
11824 SW Hwy., Suite 230  •  Palos Heights, Illinois 60463  •  847-493-3650
2001 Butterfield Rd., Suite 320  •  Downers Grove, Illinois 60615  •  847-493-3600

Notice of Privacy Practices