New Patient Form

At Back in Shape Chiropractic, our goal is to get patients healthy and keep them healthy. Appointments are never rushed and there is no waiting for treatment. In most cases, treatment can be provided during your first visit. And since it’s best to resolve pain as soon as possible, every effort will be made to accommodate same-day appointments.

Your New Patient Form


Save time by filling out your new patient form in the comfort of your own home. Simply download the form, fill it out, and bring it with you when you come for your first visit! Feel free to call 847-249-2225 with any questions.

New Patient Form

What to Expect During Your First Visit


Dr. Potetti spends the first 30 minutes of a patient’s initial visit asking questions related to their condition and then completes an examination to confirm a diagnosis. Following the examination, Dr. Potetti will share his recommended treatment plan and answer all questions.

Home care instruction (e.g., ice or heat application, avoidance of certain activities, exercises or stretches, etc.), designed to improve and sustain your well-being, will be provided at your first visit. Necessary adjustments to home care instruction are provided at subsequent visits.

Payment Methods


 Credit Cards, Cash or Check

Accepted Insurance


Blue Cross Blue Shield

Blue Cross Blue Shield, Workmans Compensation, and most other insurances accepted