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Affinity Health & Wellness Center offers our patient forms online so you can complete them in the convenience of your own home or office.

STEP 1:

New Patient Health History Form (Required for All Patients)

This lets us know the history and current state of your health or condition. 

Download & Print Health History Form

After you complete the Health History Form you can:

  • Fax it to us at ( 407-381-4490
  • Bring it with you to your first appointment.
  • or you may also email your forms to fd@affinityhealthcarecenter.com (please put NEW PATIENT in the subject line)


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.

Download & Print Auto Accident History Form
 


STEP 2:

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.

Click here to enter your information
 


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:

fd@affinityhealthcarecenter.com or fax attention Case Manager to (407) 381-4490.