Patient Advocacy Center
Instructions for Patient
Application
1443 W. Belmont Ave
Chicago, Illinois 60657
Phone: (312) 890-6613
Fax:
(312) 873-3910
wecare@thehealingclinic.org
http://thehealingclinic.org
The Healing Clinic
Instructions for Caregiver
Application
Print out the caregiver application. Complete and sign the application using black ink. If you are
uncertain about any portion of the application please leave it blank and your advocate will assist
you in completing it.
You will need to set up an appointment with a fingerprint vendor that is regulated by the state.
Print the UCIA Fingerprint Consent Form and take it with you to the appointment. Here is a list of
approved fingerprint vendors in the Chicago area:
A FINGERPINTING US PHOTO INC
6.1 Miles from THC
SHREYAS SHAH
125 S Clark St
Chicago, IL 60603
(312) 782-8144
ACCURATE BIOMETRICS INC
6.2 Miles from THC
Peggy A Critchfield
4849 N Milwaukee Ave Ste 101
Chicago, IL 60630
(773) 685-5699
ARGUS SERVICES INC
6.0 Miles from THC
Robert A Kurz
123 W Madison St Ste 1200
Chicago, IL 60602
312-377-9441
DIGBYS DETECTIVE AND SECURITY
AGENCY INC
9.4 Miles from THC
2850 S Wabash Ave Ste 201
Chicago, IL 60616
(312) 326-1100
KATES DETECTIVE AND SECURITY
AGENCY INC
17.8 Miles from THC
William J Kates
7810 S Claremont Ave
Chicago, IL 60620
773-436-3788
MOORE SECURITY INC
22.3 Miles from THC
DEBRA A MOORE-GERMAN
11828 S Western Ave
Chicago, IL 60643
(773) 617-2763
KENTECH CONSULTING INC
5.7 Miles from THC
Kenneth Coats
520 W Erie St Ste 340
Chicago, IL 60654
(312) 780-0470
MCHC-SHARED SERVICES INC
6.0 Miles from THC
222 S Riverside Plz Ste 1900
Chicago, IL 60606
(312) 906-6000
THE SECURITY MANAGEMENT
GROUP OF AMERICA INC
10.9 Miles from THC
HENRY STANTON
1824 W Pershing Rd
Chicago, IL 60609
(773) 254-1824
US BIOMETRIC SOLUTIONS INC
4.8 Miles from THC
2911 N Cicero Ave
Chicago, IL 60641
(312) 450-7200
ON Q PROTECTION AND
INVESTIGATION SERVICES LLC
1.9 Miles
ANTHONY QUINTANA
2958 W BELMONT AVE
CHICAGO, IL 60618
(773) 697-4249
Patient Advocacy Center
Instructions for Patient
Application
1443 W. Belmont Ave
Chicago, Illinois 60657
Phone: (312) 890-6613
Fax:
(312) 873-3910
wecare@thehealingclinic.org
http://thehealingclinic.org
The Healing Clinic
Items to bring to your follow up
appointment
Please bring your Caregiver Application and fingerprint scan to your first appointment along with
a government issued photo ID and two of the following items:
•
Pay stub or electronic deposit receipt issued less than 60 days prior to the date of application that
shows evidence of the applicant’s withholding for state income tax.
•
Valid voter registration card with an address in Illinois.
•
A valid, unexpired Illinois driver’s license or other state identification card issued by the Illinois
secretary of state
•
Notarized homeless status certification:
https://www.cyberdriveillinois.com/publications/pdf_publications/dsd_a230.pdf
If you are using this form, you only need this document to prove residency.
•
Bank statement, dated less than 60 days prior to application.
•
Deed/title, mortgage, rental/lease agreement.
•
Insurance policy (homeowner’s or renter’s).
•
Medical claim or statement of benefits (from private insurance company or government agency),
dated less than 90 days prior to application); Social Security Disability Insurance Statement; or
Supplemental Security Income Benefits Statement.
•
Tuition invoice/official mail from college or university, dated less than 12 months prior to
application.
•
Utility bill, including, but not limited to, those for electric, water, refuse, telephone land-line, cable
or gas, issued less than 60 days prior to application
Thanks again for choosing The Healing Clinic. We appreciate you!