New Patient Paperwork

1st Place Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • Some forms are PDF files. You will need AdobeReaderĀ® to view them.
  • If you do not already have AdobeReaderĀ® installed on your computer, Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.
  • Adult Spinal Health Form
    *Required Paperwork

    Click to Complete

  • Child Spinal Health Form
    *Required Paperwork

    Click to Complete

  • Notice of Privacy Practices
    *Required Paperwork

    Click to Complete

  • Low Back Disabililty Questionnaire
    *Optional

    Click to Complete

  • Neck Disability Questionnaire
    *Optional

    Click to Complete

OFFICE HOURS


Monday
8:00am - 6:00pm


Tuesday
8:00am - 6:00pm


Wednesday
8:00am - 6:00pm


Thursday
8:00am - 6:00pm


Friday
8:00am - 12:00pm


Saturday
8:00am - 12:00pm
*2nd and 4th Saturday of the month


Sunday
Closed

1st Place Chiropractic

1750 E Main St STE 140
St. Charles, IL 60174

(630) 491-5236