Family Medicine

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    • Michael Lesser, MD
    • Cindy MacDonald, DNP
    • Allison Teliszczak, FNP
    • Ashley Drake, FNP
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Forms

These forms may be filled out at the office, please allow extra time prior to your appointment to fill out forms. You can download, print and complete these forms, and bring with you to your first appointment.

Patient Registration Form

Financial Policy

Authorization to Disclose Protected Health Information

Notice of Privacy Practices

Do Not Resuscitate

CDL Physical Form

Diabetes Eye Exam Referral

Sports Physicals Form

School Physicals Form

Power of Attorney

Best of The Fox

Voted the Best of The Fox 3 years in a row!

Patient Forms

  • Patient Registration Form / Financial Policy
  • Authorization to Disclose Protected Health Information
  • Notice of Privacy Practices

Office Hours

Monday: 9am-5pm
Tuesday: 7am-5pm
Wednesday:  9am-5pm
Thursday: 7am-5pm
Friday: 9am-4pm
Saturday: Please Call

Meet our Medical Staff

  • Michael Lesser, MD
  • Cindy MacDonald, DNP
  • Ashley Drake, FNP
  • Allison Teliszczak, FNP
Phone: (815) 459-6655 _ Fax: (847) 658-9922 _ Located at: 1095 Pingree Road, Suite 108 Crystal Lake, IL 60014
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