Patient Forms

Complete these forms before your appointment to save time

To expedite your first visit, please download, print, and complete the following forms. Bring them with you to your appointment, or arrive 15 minutes early to complete them in our office.

New Patient Forms

Patient Information Form

Basic contact and demographic information

Download PDF

Health History Questionnaire

Detailed medical history and current symptoms

Download PDF

Consent to Treatment

Authorization for chiropractic care

Download PDF

HIPAA Privacy Notice

Notice of privacy practices acknowledgment

View Online

Insurance Forms

If you plan to use insurance, please also bring:

  • Your insurance card (front and back)
  • Photo ID
  • Insurance assignment and release form (we'll provide this)

Questions?

If you have questions about the forms or need assistance, please call us:

Prime Health + Wellness

Downers Grove: (630) 729-7024
Carol Stream: (331) 871-2039