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New Patient Forms

New patients to Spring City Health Centre are supplied with paperwork to complete before your initial appointment. To expedite acquisition of these forms, we offer then via our website. When you make your first appointment, you may indicate to us whether you would like to print out the forms offered here, or whether you would like them mailed to you.

Which Patient Forms are Needed

Patients coming to Spring City Health Centre will only need to fill out certain forms, depending upon the reasons they are seeking treatment.

Please note: Some of the forms are large files. After clicking the link for a form it may take some time for the form to appear in the new window that opens up. Please wait several minutes before calling our office. If you have a dial-up connection it may take even longer for some files to open. Thank you for your patience.

  • Allergy patients should fill out forms: 1, 2, 3, 4, and 5.
  • Pediatric patients should fill out forms: 1, 3, and 6.
  • Patients being seen for Autism should fill out forms: 1, 3, and 7.
  • People being treated for Hormones, Thyroid, and Chronic Fatigue should complete forms: 1, 2, 3, and 4.
  • All patients must sign the Payment Policy: Form #8.

  1. Patient Information Sheet
  2. Past Medical, Family and Social History
  3. Patient Consent Form
  4. Candida Questionaire & Score Sheet
  5. Comprehensive Database
  6. Pediatric Allergy Database
  7. Yeast Questionaire - Child
  8. Payment Policy

Office Visits and Phone Consults are Available
Questions? Please Call Us.

Should you need help with forms, please call us at 262-547-3055. We'll be glad to assist you.


    MONDAY FRIDAY 7:30 am 4:30 pm
        WEDNESDAY 7:30 am - 2:00 pm

Fragrance Free Office

Since a number of our patients are sensitive to various chemicals and fragrances, we require that all our patients respect our FRAGRANCE FREE facility. This includes perfumes, colognes, tobacco smoke and workplace odors or dust. If you are unsure about a particular visit, please call ahead and we will meet you in the lobby.