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New Patient Paperwork
Affinity Health & Wellness Center offers our patient forms online so you can complete them in the convenience of your own home or office.
New Patient Health History Form (Required for All Patients)
This lets us know the history and current state of your health or condition.
After you complete the Health History Form you can:
Auto Accident History Form
If you have been involved in an auto accident within one year please also complete this form along with your Health History form.
Click below to enter your basic information and it will be sent to our office manager prior to your first visit. Congratulations your done! We look forward to seeing you on your first appointment.
STEP 3: (optional)
For a quick check of your insurance coverage you can download this form: Insurance Coverage Form
We will do the best we can to have your estimated insurance coverage by the end of your visit. You can email this form to:
firstname.lastname@example.org or fax attention Case Manager to (407) 381-4490.