' Contact - Circle of Wellness | Rockford

Contact

To schedule an appointment with one of the Circle of Wellness Staff Members contact us. 
Credit card required to schedule an appointment
View our Cancellation Policy

New location is just west of Alpine Rd on Windsor Rd, in Loves Park.

Telephone: (779) 423-1700
FAX: (866) 596-1027
info@circleofwellnessrockford.com

Hours
Monday – Tuesday and Thurs – Friday: 8:30 AM to 8 PM
Wednesday: 10 AM to 7 PM
Saturdays: 10 AM to 5 PM

For questions related to special events and seminars. Email: Leila leila@circleofwellnessrockford.com

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

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

Oncology patients – Please click to download the Oncology Intake Form as well as the Physician Release Form

Weight Loss Program Intake Form

Lypossage Client Questionnaire

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 billing@circleofwellnessrockford.com

We accept insurances including:

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

    Patient First Name

    Patient Last Name

    Patient Date of Birth

    Phone

    Email

    Insured's First Name (Cardholder)

    Insured's Last Name

    Insured's Date of Birth

    Insurance Company

    Insurance Company Phone Number

    Insurance ID Number

    Group Number

    Additional Comments