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.


Hoffman Estates

Rolling Meadows

Chiropractic Rolling Meadows IL Advance Health & Wellness - Rolling Meadows