Membership Cancellation Request

Please complete the below form or call (630) 978-6280 to request to cancel your membership. Cancellation is subject to receipt and acknowledgement by RUSH Copley Healthplex.

Reason for Cancellation
This application serves as my 30-day written notification of cancellation in accordance with RUSH Copley Healthplex Contract Terms. Membership will terminate 30 days from today's date (unless bound by a current contract). Final EFT will include any and all prorate dues, house charges, and unpaid charges prior to the cancellation date of membership.
I acknowledge that cancellation cannot occur with past due balances. Any outstanding charges must be paid prior to cancellation or charges will continue to accrue.
I understand if my membership is currently in a contract, I may only withdraw from the contract for relocation of more than 25 miles of RUSH Copley Healthplex with proof of new address or documented medical reason provided by a physician. Cancellation of a contract will not be processed without providing additional documentation.