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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.

  • 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.
  • Bring the completed forms with you to your appointment, or FAX to us at 847-259-2242..

Confidential Health Information Form - Required for new patients or any patient that has not be in the office for over 1 year

This important information includes your Personal Demographics Information, your Past History, and your Current State of Health. What questions, concerns & goals can we help you with? Let us know!

Download & Print Form


Updated Contact and History Information Form - Required for a patient that has been to our office within the past year but is having a reoccurance or new condition

This information provides us with the details of your current complaint, as well as an update of your health status.

Download & Print Form


Nutrition and Internal Medicine Forms - Required in addition to the Confidential Health Information Form

Complete these forms when you have 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


Download the Free AdobeReader®

Visit us if you are a resident of Rolling Meadows, Palatine, Buffalo Grove, Arlington Heights, DesPlaines, Schaumburg or Mt. Prospect in Cook or DuPage County, IL.