New Patient Paperwork

Action 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.
  • Adult Health Form

    Click to Download

  • Youth Health Form

    Click to Download

  • Infant Health Form

    Click to Download

OFFICE HOURS


Monday
6:30am - 9:00am
3:00pm - 5:00pm


Tuesday
6:30am - 9:00am
3:00pm - 5:00pm


Wednesday
By Appointment


Thursday
6:30am - 9:00am
3:00pm - 5:00pm


Friday
6:30am - 9:00am


Saturday
By Appointment


Sunday
Closed

New Patients By Appointment Only.
*Additional times may be available upon request.

Action Wellness

2710 East Lincoln Street Suite A
Bloomington, IL 61704

P: (309) 662-8418
F: (309) 662-8197