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New Patients

After you make your first appointment, please complete the Chiropractic Patient Form. If you are coming for a nutritional evaluation, print and complete that form.

Chiropractic Forms

The chiropractic form includes questions about your stress and pain so that we can properly apply brain-balancing chiropractic principles to your treatment plan. You will also be asked to check off symptoms related to the balance of your nervous system and indicate your pain and type of pain on a diagram of the human body.

A health profile is included in the packet. We need to know your medical health profile so that we can determine appropriate methods of chiropractic.

The final form is about chiropractic and gives the doctors permission to treat you.

Please print these forms, complete them before your appointment, and bring them with you to your first appointment. It saves time and makes your appointment go much smoother.

Nutrition Patient Form

If you are seeing us for a nutrition assessment, please print and complete the Nutrition Patient Form. This is a one-page form that consists of your health profile. It is necessary to have this at your appointment.

The 4-Day Report

Day 1

The doctor will review your materials and take a thorough medical history. A detailed examination will be performed and x-rays will be taken if indicated. This time will also be used to establish your health goals and answer any questions you may have.


Days 2 and 3

Your condition will be discussed and your treatment will begin. Visits two and three are to help the doctor determine how your body will respond to treatment, so the proper treatment plan can be established.

Day 4

The doctor will present you with the plan of care to help you reach your health goals. X-rays will be explained, finances will be discussed and any questions that you have will be answered.

Don’t forget to bring your completed forms to your appointment! But first, call 217-698-5800 to make that appointment!