Welcome! On this page you can find information and forms to make your experience and treatment at our Mt Prospect and office easier. Below you will find logs and information related to patient services including: Workplace and Auto Accidents, headache logs, and our online New Patient Registration.
We use the Adobe Acrobat portable document format (.PDF) for your forms. If you don’t have Acrobat Reader, you can download it for free from Adobe’s website. Click here to download the free Adobe Reader.
New Patient Registration
We are so happy to welcome new patients to our chiropractic offices. For your convenience please complete the following two steps before your first visit. If you have any questions please feel free to call our office, Advanced Physical Medicine & Therapy (847)222-9060.
Established Patient History Update Form
If you are a former patient who hasn’t been in the office in a while, please fill out the Patient History Update Form and if your address or insurance information has changed, you may visit this page to update your information.
Workman’s Comp & Auto Accident Forms
Workplace injuries and auto accidents have a significant impact upon your quality of life. The information collected on these forms can help your doctor develop a treatment plan that is effective in reducing your pain. If your pain is a result of a work place or auto or a slip and fall accident, please include this accidental injury report form. (17.4K .PDF)
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.