Designed by: OOT Box Media, LLC

2700 W Lawrence Ave.

Suite J-4

Springfield, Illinois 62704

217.546.6698

New Patients

As a first time patient at Westside Pain Clinic we will need to get a little information about you. Analyzing your past issues or injuries helps us provide you with the best Chiropractic Care we can. Review the New Patient Form to have the information ready when you come in or print it off and bring it in. Feel free to contact us with any questions.

Motor Vehicle / Personal Injury Forms

If you have been in an accident or experienced an injury this paperwork will provide us with a little more information as to what happened and what care you have received up to this point. This allows our Chiropractors to offer you the proper services to get you feeling your best!

Returning Patients

When returning to Westside Pain Clinic we like to make sure all of your information is up-to-date in our system and get an idea of what new issues or pain you are having. These forms are typically only needed if you are having new problems or need to update your contact information. If you visit us regularly these are not required.

Workers Compensation Forms

Injuries while on the job are typically covered by your employer's Worker's Compensation Insurance. These forms provide us with your employer's information and insurance so that we can help you make sure your Chiropractic Care is covered. They also give us a little more information about the injury so we can better service you.