For your convenience, Daniels Chiropractic Office offers our patient form(s) online, so they can be completed in the comfort of your own home or office.   

• If you do not already have AdobeReader® installed on your computer, Click Here to download and install.
• Download the necessary form(s), print and complete the required information.
• Fax us your completed form(s), or bring to your first appointment.
• Our fax number is (262) 638-0742.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, and goals regarding wellness can we help you with? Let us know! This form includes the 'Patient Information Sheet' and 'Neck and Back Questionnaire.' 

Download & Print Form

Personal Injury Form 

If you have been in a motor vehicle collision or experienced other personal injury, please download, print, and complete this form before your first office visit.

Download & Print Form

Workers Compensation Form 

If you would like to have your treatment billed as a workers compensation claim, please download, print, and complete this form before your first office visit.

Download & Print Form

Patient Information Sheet

All patients are required to complete the Patient Information Sheet once to ensure that our records are correct and up-to-date.  

Download & Print Form

Neck and Back Questionnaire

If you are an established patient and the doctor requests you fill out an updated questionnaire you can download and print it here. 

Download & Print Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!