Chiropractors and Physical Therapists in Mount Prospect IL 60056 [Advanced Physical Medicine and Therapy: 847-222-9060] and West Dundee IL 60118 [West Dundee Physical Medicine: 847-844-7900].

Comprehensive chiropractic and physical therapy care services for total health. Serving patients in Chicago's northwest and western suburbs.

Forms to Download

We've included several forms here that will make your experience and treatment at both of our offices easier. You can download these forms, or open them here and print copies. Please complete the forms and bring them with you to your appointment

We use the Adobe Acrobat portable document format (.PDF) for our forms. If you don't have a version of Acrobat Reader, you can download it for free from Adobe's website. Click here to download the free Adobe Reader.

New Patient Forms

For your first appointment with us, please complete these forms. The Welcome Package will tell us about your medical history, as well as the pain and problems that bring you to our offices.

The other forms give us your permission to treat you, permission for us to have a radiologist read your X-ray results, and inform you of your rights and responsibilities as our patient. You can complete the forms and fax them to our offices before your first appointment, or you can bring them with you.

Forms for Mount Prospect Office (Fax back to 847-222-9130) Forms for West Dundee Office (Fax back to 847-844-7941)
Accident Forms

If your pain is a result of an accident, either on the job or during your personal time, please include this accidental injury report form form. (17.4K .PDF)
Headache Log

Having trouble with recurring headaches? Download this headache log (81K .PDF) and use it to keep track of your headaches. Knowing how often your headaches occur. and what you think causes them (stress, foods, activity, allergies, etc.), will help us treat your pain more effectively.