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Patient Forms
Please download the patient information forms for the office location of your choice. For your convenience, you may type directly on to these documents. Once completed, simply print, sign and date them. In order to expedite your first visit, please arrive at least 15 minutes early to allow our team to process your information.

• Arlington Heights Office
  • Patient Registration Form
  • Medical History Form
  • Financial Policy Form
  • Notice of Privacy Practices - Signature Page
  • Authorization for Disclosure
  • Form to Request Medical Records from Affinity Health Care
    


• Wauconda Office
  • Patient Registration Form
  • Medical History Form
  • Financial Policy Form
  • Notice of Privacy Practices - Signature Page
  • Authorization for Disclosure


• Algonquin Office/Lake Zurich Office
  • Patient Registration Form
  • Medical History Form
  • Consent for Treatment Form
  • Authorization of Information Form
  
  
• Motion Werks Gait Analysis Center
  • Patient Registration Form
  • Medical History Form
  • Financial Policy Form
  • Notice of Privacy Practices - Signature Page