New Patient Request



Congratulations on Talking Action! Dr. Blahnik and the staff at NEXT LEVEL Health Clinics welcome you

  • I am looking for a holistic approach to addressing my health needs
  • I will fill out the form below right now & take steps that will bring my health to the Next Level
  • I want a clinic representative contact me to confirm my appointment

New Patient Request Form

Instructions: Please select an available time to come in and one of our staff will call you to confirm or adjust your appointment schedule. All appointments are in One Hour increments.

*please choose up to 3 times that normally work for your schedule.
Monday
Tuesday
Wednesday
Thursday
Name
Email Address
Phone Number
Reason for Scheduling an Appointment:
Enter the characters as displayed in the graphic to the right.
Enter the characters as displayed in the graphic to the right.

Contact Information

Contact us directly during our business hours:

ROCKFORD Phone: (815) 708-6195
Email: info@NextLevelHealth.com

Stop by our office: 2835 McFarland Rd, Suite D – Rockford, IL 61107  map

Rockford Hours of operation:

Monday: 11:30AM – 1:30PM & 4:00PM-6:00PM
Tuesday: 4:00PM-6:00PM
Wednesday: 11:30AM – 1:30PM & 4:00PM-6:00PM
Thursday: 4:00PM – 6:00PM (6:30PM – 8:00PM Clinic Orientations & X-Ray Report of Findings)
Saturday:  10:00AM Weight Loss Appointments Only

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