DISPENSARY CHANGE FORM

If you would like to become a patient at HCI Alternatives, please provide the following information and we will submit the proper paperwork.

HCI ALTERNATIVES - SPRINGFIELD

628 EAST ADAMS

SPRINGFIELD, IL 62701

217-679-3283

SPRINGFIELD@HCILLINOIS.COM

HCI ALTERNATIVES - COLLINSVILLE

1014 EASTPORT PLAZA DRIVE

COLLINSVILLE, IL 62234

618-381-9229

COLLINSVILLE@HCILLINOIS.COM