Helping Families Live Pain Free without Drugs
 Dr. David A. Rominski, D.C.   Dr. Timothy F. Filippini, D.C.   Dr. Cori M. Wiedrich, D.C.
 2410 Alft Lane   Suite 100   Elgin, Illinois  60124
(847) 888-3383
Home
 Office Hours
FAQ
 Patient Forms
About the Staff  
About the Doctors  
Map to Our Office
  Neck Pain
Lower Back Pain 
Headache
ShoulderPain
Carpal Tunnel
Sciatica
Pinched Nerve


Chiropractic Care for
the Whole Family

 
Wellness Directory
Click links below to learn more. 
Auto Accidents
Whiplash
Work Injury
Sports Injury
SEMG
Orthotics
Diversified Technique
Myofascial Release
Acupuncture
Massage Therapy
Ten Steps to Wellness
Pinched Nerves
Golf and Your Back
Fibromyalgia
Leg Pain/Sciatica
Sleep
Nutrition
Senior Fitness
Arthritis
Osteoporosis
Pregnancy
Exercises
Testimonials
History of Chiropractic


Payment Options
PPO
Blue Cross/Blue Shield
Automobile Insurance
Attorney Liens
Worker's Compensation
Patient Financing Available
Visa/MasterCard




 

Patient History Forms

Note to chiropractors:  We will place on this page your
own forms, or you may use the ones below.



Auto Injury Form

Normal Patient History Form

DISCLAIMER: No individuals, including those under our active care, should use the information, resources or tools contained within to self-diagnose or self-treat any health-related condition. Diagnosis and treatment of all health conditions should only be performed by your doctor of chiropractic or other licensed health care professional.

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