Behavioral Health History Forms - Appleton
History forms - Affinity Medical Group Behavioral Health, AppletonPrint 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:
1531 S. Madison St.
Appleton, WI 54915
Questions? Call (920) 730-4411