Circle of Wellness Rockford IL

Patient Intake Form - Rockford, IL

If you are not currently a patient, please call to schedule an appointment before filling out this form.

All new patients must complete the following intake form and Body Scan Tool Consultation Request form prior to their appointment.  Link to the Body Scan tool form can be found on the Patient Forms page.  

Body Scan Tool

To request a consultation,
complete the Body Scan Tool