New Patient Paperwork

Acupuncture Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.
  • Confidential Patient Information

    Click to Download

  • Health History

    Click to Download

  • Pain Diagram

    Click to Download

OFFICE HOURS


Monday
3:00pm - 7:00pm


Tuesday
Closed


Wednesday
10:00am - 12:00pm
3:00pm - 7:00pm


Thursday
Closed


Friday
3:00pm - 7:00pm


Saturday & Sunday
Closed

Acupuncture Chiropractic

500 Park Ave STE 101
Lake Villa, IL 60046

(847) 265-BACK (2225)