Patient Forms

Regardless of when you complete the forms, please be sure to tell us about all your symptoms and any changes in those symptoms. Do not minimize any symptoms - even if you feel that they're not related to your condition, we need to know about them. You should also be completely honest about your lifestyle. For example, if you use tobacco, alcohol or drugs (prescription or illicit), please tell us. This information will be held in the strictest confidence in accordance with federal and state law and will only help to guide your doctor toward the most appropriate plan of care.

In addition, try to be as specific as possible. Tell us:

· When your symptoms started

· What they feel like

· How they’re affecting your life

· What makes the symptoms better and/or worse

The more descriptive your explanation, the more helpful it is. Of course, it's important to tell us if you are or may be pregnant. X-rays generally aren't used on pregnant women because of the possible risk of radiation exposure to the developing baby.

If you wish, you may print and complete the below forms before arriving for your first visit. Of course, you may also obtain and complete these forms at our office.

New Patient Registration and Case Record Forms 314kb PDF

Call us today at (847) 673-6600 to make an appointment!

Office Hours:

M-W-F:

9am-12:30pm & 3pm-7pm

Tu:

3pm-7pm

Th:

9am-12:30pm

Sat:

8am-11am

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Healing Hands Wellness & Chiropractic Center

www.HealingHandsOfSkokie.com phone: (847) 673-6600 fax: (847) 673-6601