Call Us: (815) 469-7472
Call Us: (815) 469-7472

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