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

(618) 236-3600