New Patient Paperwork
Swansea Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office. Click "Submit" at the end of each form, and it will come directly to our office. The doctor will review your answers in preparation for your first visit.
1. Complete one of the following new patient intake forms, depending upon the patient's age:
2. Review and sign our Assignment of Benefits form:
Monday
9:00am - 12:00pm
2:00pm - 6:00pm
Tuesday
2:00pm - 6:00pm
Wednesday
9:00am - 12:00pm
2:00pm - 6:00pm
Thursday
2:00pm - 6:00pm
Friday
9:00am - 12:00pm
Saturday & Sunday
Closed
Swansea Chiropractic
3 Park Pl Suite B
Swansea, IL 62226