New Patient Paperwork

Crystal Lake Family Wellness offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.

New Patient Health History (ages 12 and older)

Pediatric New Patient Health History (ages 11 and younger)

Monday
9:00am - 11:00am
3:00pm - 6:30pm


Tuesday
3:00pm - 6:00pm


Wednesday
9:00am - 11:00am
3:00pm - 6:00pm


Thursday
9:00am - 11:00am
3:00pm - 6:00pm


Friday
Closed


Saturday
8:30am - 9:30am

Crystal Lake Family Wellness
4777 Northwest Highway Suite C
Crystal Lake, IL 60014
(815) 788-7504