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Queen's Health Center

Premier Wellness Place for the Whole Family

Forms to bring to your FIRST appointment

Please note all forms and applications are in PDF format, hence it is necessary to print them out and fax them to QHC II prior to your appointment or bring them with you if you are coming to the appointment in person. 

Fax #: 215-721-8836

Client Consent Form

Please fill out this form before your 1st appointment

Informed Consent

Form 7 7 2011.pdf

(PDF — 76 KB)

Health Questionnaire

Please fill out this form before your 1st appointment

MET427 HAQ

Health History.pdf

(PDF — 30 KB)



707 & 711 Rt. 113

County Line Plaza

Souderton, PA 18964

For Appointments QHC II 215-721-8828

Store Phone: 215-721-0577

Email: [email protected]


QHC Fax: 215-721-8836

Store Fax: 215-721-9853

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