New Patient Forms

In order to better meet our patients' needs we have included a link to our registration form.

Click on the link and print and complete the form prior to coming into the clinic for your initial evaluation.

• Patient Questionnaire (pdf)
• Neck Disability Index (word)
• Dizziness Handicap Inventory (word)
• Lower Back Pain Disability Questionaire (word)
• Temporomandibular Disorder Disability Index (word)

To view the patient questionnaire you will need Adobe Acrobat reader. If you do not currently have acrobat reader you can download the software for free by clicking here.

If you have any questions please contact us at 815-756-8524 (DeKalb), 815-562-3299 (Rochelle), or 815-784-6417 (Genoa).