Diagnosis and Evaluation of Attention, Memory, Emotional, and Learning Difficulties for All Ages
Diagnosis and Evaluation of Attention, Memory, Emotional, and Learning Difficulties for All Ages

What to know before your appointment:

Before your visit with us, please make sure to bring the following with you:

  • The completed pre-visit questionnaire (links provided below),
  • Any pertinent medical records that you may have (if these are not readily available, a Release of Information form will be provided at your appointment for Thomson Memory Center to obtain your records),
  • Insurance cards

 

Pre-Visit Questionnaire for Children age 15 and under
CHILD Medical Questionnaire 2018.pdf
Adobe Acrobat document [216.0 KB]
Pre-Visit Questionnaire for Young Adults age 16-22
Young Adult Questionnaire 2018 ages 18-2[...]
Adobe Acrobat document [301.4 KB]
Pre-Visit Questionnaire for Adults age 23+ and Seniors
Adult Questionnaire 2018-2.pdf
Adobe Acrobat document [402.4 KB]
Pre-Visit Questionnaire for Post-Concussion Patients
Medical Questionnaire CONCUSSION-4 18 18[...]
Adobe Acrobat document [359.6 KB]
Child Re-Evaluation Questionnaire
CHILD Medical Questionnaire Re-Evaluatio[...]
Adobe Acrobat document [211.6 KB]
Adult Re-Evaluation Questionnaire
Adult Re-Eval Medical Questionniare.pdf
Adobe Acrobat document [338.1 KB]
Privacy Policy
Privacy Policy.pdf
Adobe Acrobat document [56.3 KB]

LOCATIONS

(IL/MN)

(Click for map)

ILLINOIS

Algonquin, IL

1451 Merchant Dr.

Algonquin, IL 60102

 

Barrington, IL 

120 N. Northwest Hwy.

Barrington, IL 60010

 

Chicago - Lincoln Park, IL

939 W. North Ave. Ste 750

Chicago, Il 60642

 

Deerfield, IL

500 Lake Cook Rd. Ste 350

Deerfield, IL 60015

 

Hoffman Estates, IL

2300 Barrington Rd. Ste 400

Hoffman Estates, IL 60169

 

Oak Brook, IL

700 Commerce Dr. Ste 500
Oak Brook, IL 60523
 

Park Ridge, IL

350 S. Northwest Hwy. Ste 300

Park Ridge, IL 60068

 

St. Charles, IL

100 Illinois St. Ste 200

St. Charles, IL 60174

 

MINNESOTA

Lake ElmoMN

8530 Eagle Point Blvd Ste 100

Lake Elmo, MN 55042

 

Roseville, MN

2355 Highway 36 West Ste 400

Roseville, MN 55113

 

IL: (847) 469-7537

MN: (612) 224-2644

Fax: (847) 469-7540

info@thomsonmemory.com

askthedoc@thomsonmemory.com

 

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