New Patient Forms

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, including physiotherapy, soft tissue therapy and spinal adjustments, 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 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.

Call to request an appointment
(847) 249-2225

New Patient Forms


Save time by filling in your new patient paperwork in the comfort of your own home. Just download the form, fill it in, and bring it with you when you come for your first visit!

Get the form

*The form is provided as a PDF download. If you have trouble opening it or don’t already have a PDF reader, Adobe Reader is the most popular free PDF reader available.

Payment Methods


We accept credit cards, cash or check.

Insurance


Blue Cross Blue Shield

Blue Cross, Blue Shield, and most other insurances are accepted.

Workers’ Compensation