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.

  • Adult Spinal Health Form

    *Required Paperwork
    Click to Complete

  • Notice of Privacy Practices

    *Required Paperwork
    Click to Complete

  • Pediatric Intake

    *Optional
    Click to Complete

  • Medicare Progress Notes

    *Optional
    Click to Complete

  • Low Back Disability Questionnaire

    *Optional
    Click to Complete

  • Neck Disability Questionnaire

    *Optional
    Click to Complete

OFFICE HOURS

Monday
8:00am - 12:00pm
3:00pm - 6:00pm

Tuesday
8:00am - 11:00am
2:00pm - 6:00pm

Wednesday
Closed

Thursday
8:00am - 12:00pm
3:00pm - 6:00pm

Friday
9:00am - 12:00pm

Saturday
9:00am - 12:00pm
*2nd Saturday of the month

Sunday
Closed

1st Place Chiropractic

1750 East Main Street #140
St. Charles, IL 60174
P: (630) 491-5236
F: (630) 584-8370