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Hospital Statement of Cost BHF Page 1Healthcare and Family Services, Bureau of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763General InformationPreliminaryName of Hospital: Van Mate Health
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To fill out the Van Matre HealthSouth Rehabilitation form, follow these steps:
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Begin by obtaining a copy of the form. You can usually find it on the Van Matre HealthSouth Rehabilitation website or by visiting their office.
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Fill in your personal details such as your name, address, contact information, and date of birth.
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Provide your medical history, including any illnesses, injuries, surgeries, or chronic conditions you have experienced.
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Sign and date the form to confirm the accuracy of the information provided.
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Submit the form by either mailing it to the Van Matre HealthSouth Rehabilitation office or by submitting it online, if available.
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If you have any questions or need assistance with the form, contact the Van Matre HealthSouth Rehabilitation office for further guidance.

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