1st Visit Online Forms

Affinity Health & Wellness Center offers our patient form(s) online so you can complete it in the convenience of your own home or office.

STEP 1

New Patient Health History Form {Required for all patients}

This let’s us know the history and current state of your health or condition. 

Download & Print Health History Form            

After you complete the Health History form you can:

• Fax it to us at ( 407-381-2277 ) 
• Bring it with you to your first appointment.
• or you may also email your forms to deborah@affinityhealthcarecenter.com (please put NEW PATIENT in the subject line)

If you have been involved in an auto accident within one year please also complete this form along with your Health History form.

Download & Print Auto Accident History Form

STEP 2

Click below to enter your basic information and it will be sent to our office manager prior to your first visit. Congratulations your done!  We look forward to seeing you on your first appointment.

Click here to enter your information
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STEP 3 (optional)

For pre-verification of your insurance you can download this form: Insurance pre-certification form

We will do the best we can to have your estimated insurance coverage by the end of your visit.  You can email this form to:

aliana@affinityhealthcarecenter.com or fax attention Case Manager to (407) 381-2277.