Circle of Wellness Rockford IL

Intake Forms
Please complete the forms and bring it to your first appointment.

If you are a new patient, Click here to download the new patient intake form.

No Show Policy Form

Non Solicitation Form

Insurance Patients – Please click to download the following forms

General Insurance Information Form

ABN Form

Oncology Patients – Please click to download the Oncology Intake Form as

Physician Release Form

Body Scan Tool

Consultation Request Form Coming Soon

Insurance Verification Form

The following form is to be used collect insurance information from patients that wish to see if their insurance will cover services provided at Circle of Wellness.  By submitting this form, you agree to allow the Circle of Wellness billing department to contact your insurance.

For questions call or email the billing department 779-423-1700 or [email protected]

We accept insurances including:

We also accept flexible spending accounts, and auto accident injury claims.

Body Scan Tool

To request a consultation, complete the Body Scan Tool questionnaire.