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GET STARTED

Not sure where to start? Fill out our questionnaire.

Welcome to Elite! To ensure a smooth and efficient process during your appointment, we kindly ask you to fill out the questionnaire prior to your visit. With this information, we will contact you in 1-2 business days and set you up in our Patient Portal. 

This will help us to better understand your needs and ensure that we can address any concerns you may have. Thank you for your cooperation and we look forward to seeing you soon.

You can also contact us at:

PHONE: 920.215.0054

FAX: 833-450-5102

EMAIL: info.eliteinfusiontherapies@gmail.com

***GET HIPAA FORM***

* PLEASE COMPLETE FORM | Health Intake Questionnaire
Doctor's Desk
PLEASE SIGN & SEND TO FAX OR EMAIL FOR TELEHEALTH CONSULTAIONS.

Health Intake Questionnaire

Please fill out the following form in order to participate in our facility.

Personal Information | Medical Information | Personal History  | Intake Signature

Personal Information

Assessment 

Please select best answer from the drop down menu to help us understand your needs.

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