Want to save 20 minutes on your first visit?
Print out the forms below and you can fill them out in the comfort of your own home. Please remember to bring them with you to your visit.
Please take the time to fill the paperwork out completely and accurately as it is essential for your doctor to assess your total health picture as it relates to your condition.
If you are interested in using your health insurance, use the form below
to contact them and find out what is covered. Please bring this
completed form and your insurance card with you to your visit.
New Patient Packet
Insurance Verification Form
If you are a technologically savvy individual and prefer, you may also fill it out, scan it and send it to us at info@functionalhealthchiro.com or call (847-605-8835) and ask for our fax number.
Please take the time to fill the paperwork out completely and accurately as it is essential for your doctor to assess your total health picture as it relates to your condition.
If you are interested in using your health insurance, use the form below
to contact them and find out what is covered. Please bring this
completed form and your insurance card with you to your visit.
New Patient Packet
Insurance Verification Form
If you are a technologically savvy individual and prefer, you may also fill it out, scan it and send it to us at info@functionalhealthchiro.com or call (847-605-8835) and ask for our fax number.