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®