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25 W. Lincoln Ave. Charleston, IL 61920
217-345-9600
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Back to Health Chiropractic & Natural Health Care offers our patient form(s) online so they can be completed it 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.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.


New Patient Health History Form - General

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Complete New Patient Information Here

If patient is under the age 18, please fill our New Patient paperwork listed above AND under age 18 forms here.

Worker's Compensation (or) Personal Injury paperwork needs to be filled out in our office. 



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