New Patient Paperwork

Advance Health & Wellness offers our patient form(s) online so they can be completed in the convenience of your own home or office.

All forms are PDF files. You will need AdobeReader® to view them.
If you do not already have AdobeReader® installed on your computer, Click Here to download.
Download the necessary form(s), print them out and fill in the required information.
Bring the necessary form(s) to your appointment.

Patient Registration Packet
Click to Download
Patient Symptoms Form
Click to Download
Acupuncture Form
Click to Download
PAR-Q Form
Click to Download
Men's Fertility Questionaire
Click to Download
Women's Fertility Questionnaire
Click to Download
Insurance Findings
Click to Download

Most major insurance accepted and Payment Plans

Some insurance providers we accept are BCBS, Aetna, CIGNA, Smart Health, NCH etc. We also accept Medicare.

Individuals in need of our services who do not have insurance or plan to pay out of pocket need not worry. We have affordable rates and flexible payment plans allowing access to high-quality care for you and your family.

OUR LOCATIONS:

Hoffman Estates

Rolling Meadows