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Online Forms

Jachimek Chiropractic Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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 - Required

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!

Download & Print Form



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Location

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Office Hours

Our Regular Schedule

Monday:

8:00 am-12:00 pm

1:00 pm-6:00 pm

Tuesday:

Closed

Wednesday:

8:00 am-12:00 pm

1:00 pm-6:00 pm

Thursday:

Closed

Friday:

8:00 am-12:00 pm

1:00 pm-6:00 pm

Saturday:

Closed

Sunday:

Closed

Testimonials

Reviews By Our Satisfied Patients

  • "I work and play hard if I didn't regularly visit the wonderful chiropractor and staff at Jachimek Chiropractic, I would not be able to continue doing what I love."
    -K.B.
  • "I started chiropractic 3 weeks ago due to a painful hip. Dr. G is great and has a very pleasant bedside manner. My hip is improving each day and I am so thankful!!!"
    - June B.