Clinical Forms

New Patient Administrative

A.

Confidential Health Information Questionnaire

E.

Consent to Email,

Text & Voicemail

B.

General

Medical History

F.

Financial Policy

C.

Integrative Health Policy & Consent to Care Agreement

D.

Hippa Privacy Policy, Treatment Consent, Claims Processing Consent

Functional Medicine

1.

Functional

Medicine

2.

Neurotransmitter Assessment Form (NTAF)

3.

Metabolic

Assessment

4.

Understanding

Our Goals

Chiropractic

1.

Patient Health Questionnaire – PHQ

5.

Functional Rating Upper Extremity

2.

Patient Follow-up Questionnaire

3.

Functional Rating Neck and Back Index

4.

Functional Rating Lower Extremity

Acupuncture

1.

New Patient Intake

Massage

2.

New Patient Intake

1.

Terms & Waiver

Misc.

1.

Release of

Medical Records

INFO
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HealthFit is newly built all-in-one medical, fitness, activity and performance center committed to helping our patients achieve optimal health, be it physical, mental or emotional, by providing them with a  comprehensive plan that is easy to achieve and maintain with the necessary guidance and support from experienced and friendly practitioners who feel more like family.

We service Arlington Heights, Mount Prospect, Palatine,  Hoffman Estates, Schaumburg, Buffalo Grove, Prospect Heights, Wheeling, Des Plaines, Elk Grove Village, and the entire Northwest  suburban community.

© 2020 By Healthfit