Online Forms

Haque Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Click here to complete the form

CRYOSKIN Intake Form

Click here to complete the form

New Patient Paperwork

Download & Print Form


Download the Free Adobe Reader®

Location

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Office Hours

Our Regular Schedule

Primary Office

Monday

9:00 am-1:00 pm

Tuesday

Closed

Wednesday

9:00 am-12:00 pm

3:00 pm-6:00 pm

Thursday

7:00 am-1:00 pm

Friday

Closed

Saturday

Closed

Sunday

Closed

Primary Office

Monday
9:00 am-1:00 pm
Tuesday
Closed
Wednesday
9:00 am-12:00 pm 3:00 pm-6:00 pm
Thursday
7:00 am-1:00 pm
Friday
Closed
Saturday
Closed
Sunday
Closed