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Behavioral Health History Forms - Appleton

History forms - Affinity Medical Group Behavioral Health, Appleton

Print and complete the appropriate form. Mail or deliver to the address listed below.

Behavioral Health History Form - Adult (6 pages)

Behavioral Health History Form - Child/Adolescent (9 pages)

Patient Insurance Form (1 page)


Send completed forms (via mail or in person) to:

Affinity Medical Group - Behavioral Health
Attn: Scheduling
1531 S. Madison St.
Suite 580
Appleton, WI 54915



Questions? Call (920) 730-4411