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Online Forms

Rockford Chiropractic Clinic offers our patient form(s) to be filled out online or downloaded so they can be completed in the convenience of your own home or office.  THESE FORMS ARE ONLY FOR CHIROPRACTIC PATIENTS.

  • Click on the link below to go to site for online versioin
    • This link provides English or Spanish option.
    • Simply follow the instructions all the way to the end.
      • Easy and fast!  If able, this is my preferred option.
      • The information is then loaded into your file for review
  • OR
  • If you do not already have AdobeReader® installed on your computer, click here to download.
    • Download the necessary form(s), print it out and fill in the required information.
    • Fax us your printed and completed form(s) or bring it with you to your appointment.

Intake Forms

Patient Online Intake Form link to fill out online in either English or Spanish (no printing!):

https://intake.mychirotouch.co...

or, view and download Intake Forms now and print (English Only).

Standard Intake English Version

Additonal Auto Accident Intake English Version


Download the Free Adobe Reader®

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QUESTIONS?

See our online scheduler page to make an appointment or request acces. Please only use this form to submit questions to our clinic.

Location

Find us on the map

Business Hours

Our Regular Schedule (Saturday's subject to change)

Monday:

9:00 am-6:00 pm

Tuesday:

9:00 am-4:00 pm

Wednesday:

9:00 am-6:00 pm

Thursday:

2:30 pm-6:00 pm

Friday:

9:00 am-4:00 pm

Saturday:

Closed

Sunday:

Closed