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Online Forms

Balanced Care Chiropractic offers our patient forms online so they can be printed and 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.
  • Fax us your printed and completed forms or bring with to your appointment. 
  • Fax # 847.466.5764

New Patient Forms - Required


Adult Intake Forms   (click and print)

IN ADDITION, PLEASE FILL OUT THE FORM, OR FORMS, APPROPRIATE FOR YOU CURRENT CONDITION(S):

 - Back Pain (click and print)

 - Neck Pain  (click and print)

 - Headaches  (click and print)

 - Arm, Shoulder, and Hand  (click and print)

 - Leg, Knee, Ankle, and Foot  (click and print)


Child Intake Forms (click and print)   (For age 0 to 13)



Download the Free AdobeReader®

Balanced Care Chiropractic

Office Hours

Balanced Care Chiropractic

Monday:

9:30 am-12:30 pm

3:30 pm-6:30 pm

Tuesday:

9:30 am-12:30 pm

Wednesday:

9:30 am-12:30 pm

3:30 pm-6:30 pm

Thursday:

Closed

Friday:

9:30 am-12:30 pm

3:30 pm-6:30 pm

Saturday:

9:00 am-12:00 pm

Sunday:

Closed

Testimonials

  • "Can't wait to see Dr Stephanie again today! She saved my 26-33 week pregnant back, pelvis and hips! Without her I would still be in excruciating pain. I cannot say enough good things about Balanced Care!
    Strongly recommend!!!!!!
    Thank you Dr. Stephanie!!!"
    Robin S.