Patient Center

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.

  1.  APMT Patient Registration –  Click this link to complete your registration will take you to an online registration page. 
  2. New Patient Form – Please complete this form about why you are coming to our office.

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)

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.

Permanent link to this article: http://apmt.us/mount-prospect-patient-center/

Lifestyle Education Patient Forms

This page provides links to the various forms you will need to participate in the Lifestyle program.  All forms are in PDF format and can be downloaded and printed at home. Metagenics – Order Medical Foods Metagenics offers 20% off your first order and 10% off on recurring orders.  In addition, shipping is free for …

View page »

Standard Process

Order Supplements

For our patients’ convenience, you may order from the following companies and have your supplements shipped directly to your home. Please speak to Dr. Patel or Dr. Kolbaba about supplement recommendations based upon your health history.  We choose to work with the following companies based upon their high quality bio-available supplements.  Why is this important? …

View page »

Chiropractic New Patient Registration

We are so happy to welcome new patients to our chiropractic offices.  For your convenience please complete the following form.  If you have any questions please feel free to call our office, Advanced Physical Medicine & Therapy (847)222-9060.   New Patient Form – Please complete this form about why you are coming to our office. …

View page »

Notice of Privacy Practices (HIPAA)

Effective November 16, 2010 Our offices comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) This notice describes how health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully. The privacy of your health information is important to us. Get …

View page »

Chiropractic Care FAQs

Ask Us… We are so glad you found our chiropractors in Mount Prospect.  You may not think of visiting a chiropractor to treat your headaches, ankle pain, or numbness in your fingers or toes. Because your spine feeds the nerve system of the rest of your body, many of your health problems are treatable through …

View page »