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Online Forms

Arlington Chiropractic Clinic offers our patient forms online, so that you can complete them in the convenience of your own home or office. Bring the completed forms with you to your appointment, or FAX to us at 847-259-2242.


Confidential Health Information Form

- Required for all patients

Download & Print Form


Nutrition and Internal Medicine Forms

- Required for patients experiencing internal symptoms OTHER THAN musculoskeletal complaints.

Examples: stomach problems, hormone complaints, fatigue, infections, headaches and other internal disorders. If you are unsure if you should complete these forms, it is better to do them, and give the doctors more information about you.

Medical Symptoms Questionnaire - Download

Health Evaluation Questionnaire - Download

Confidential HRT Questionnaire - Download (Females Only)