Online Forms
Holistic Health & Chiropractic of Frankfort offers our patient form(s) online so they can be completed in the convenience of your own home. This will help expedite your time here in our office. If for some reason you are not able to complete these forms at home, please be sure to come in 15 minutes before your scheduled appointment time.
- 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) at (815) 412-9306 or bring it with you to your appointment.
General New Patient Form - Required
Agreement to Alternative Care- Required
HIPPA- Required
Medical Symptom Questionnaire Form - Required
General Pain Disability Index Questionnaire Form - Required
Functional Medicine Registration - Optional
Auto Accidents Form - Optional
Workers Comp. Form - Optional
Notice of Patient Privacy Policy
Holistic Health & Chiropractic of Frankfort
| Monday | 9:00 - 1:00 | 3:00 - 6:00 |
| Tuesday | Closed | 3:00 - 6:00 |
| Wednesday | 9:00 - 1:00 | 3:00 - 6:00 |
| Thursday | 9:00 - 1:00 | 3:00 - 6:00 |
| Friday | Closed | Closed |
| Saturday | 9:00 - 1:00 | Closed |
| Sunday | Closed | Closed |