New Patient Paperwork
Eickhorst Family Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® 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.
auto accident & workers comp
Please complete this form if your symptoms are due to an auto accident and there is an auto insurance carrier claim. This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
We are In-Network with Aetna!
We accept most insurances and are in-network with Blue Cross Blue Shield, and Medicare!
OFFICE HOURS
Monday
9:30am - 12:30pm
3:00pm - 6:00pm
Tuesday
9:30am - 12:30pm
3:00pm - 6:00pm
Wednesday
9:30am - 12:30pm
3:00pm - 6:00pm
Thursday
9:00am - 1:00pm
Friday
Closed
Saturday & Sunday
Closed
Eickhorst Family Chiropractic
5190 Euclid Ave
Palatine, IL 60067
F: (847) 202-0070