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elcome to the Balance Chiropractic Clinic new patient center!

We understand that arriving at a doctors office for the first time can be nerve racking. Filling out paperwork, learning new faces and names, and getting to know your way around the office can be an overwhelming experience.

That’s why at Balance Chiropractic Clinic our aim is to remove any stress or causing unnecessary tension and to make you feel comfortable. In this area of the website you will be able to take care of items necessary for your visit prior to arriving, in the comfort of your own home.

Chiropractic New Patient Health History Form

Web Intake Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor,

Download & Print Form
  • 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 (309) 268-9003 or bring it with you to your appointment.