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Patient Forms

Save some time by filling out paperwork at home. This way we can get to you sooner and provide the relief you deserve. Each of the forms can be printed at your convenience to be filled out at your pace. You may also fax your forms to the office. Questions? Call us at (815) 692-2802 or fax us at (815) 692-3340

New Patient Forms
New to our office? Here you can download or New Patient Forms and save some time. This way we can get to you as soon as possible and get you some relief.
newPatientForms.pdf
Text document [30.5 KB]
Pain Assessment Form
Rate your pain so our Doctors have a clear objective assessment of your condition.
Functional.Rating.Index.2015.pdf
Adobe Acrobat document [36.9 KB]
Personal Injury
Injuries occur in life, and when they do, we are here to help. If you are being treated for an injury, please fill out this form in its entirety.
personalinjuryform.doc
Text document [85.5 KB]
Auto Case Forms
Unfortunately accidents happen. In case you were in an accident, these are the forms needed to be completed. We can gladly help to get your life back on track.
autoaccidentform2012.doc
Text document [62.7 KB]
Work Comp Forms
Hurt on the job? These forms are needed to before treatment to get you back on the job.
workcompform2012.doc
Text document [88.5 KB]
perfect alignment "Restoring Your Quality of Life One Adjustment at a Time"

Contact Us

Send Us An Email Today!

Our Location

109 W Walnut St. | Fairbury, IL 61739

Office Hours

Find Out When We Are Open

Closed daily 12pm-1pm

Monday:

8:00 am-6:00 pm

Tuesday:

8:00 am-6:00 pm

Wednesday:

Closed

Thursday:

8:00 am-6:00 pm

Friday:

8:00 am-6:00 pm

Saturday:

8:00 am-12:00 pm

Sunday:

Closed