Online Forms
To save time on your first visit, we encourage you to complete the required intake forms before you come in to see us.
- Download the appropriate intake form and financial agreement/consent to treat and complete requested info.
- Fax (715-262-8744) or email (prescottchiro@gmail.com) your completed forms or bring them with you on the day of your appointment.
New Patient Health History Intake
ADULTS (Age 18-64)
CHILDREN (Newborn to Age 17)
ConsentToTreatMinor.pdf (Parent/Guardian must sign this form for all minors under the age of 18 prior to being seen)
PREGNANT WOMEN
MEDICARE (Age 65+)
Medicare ABN (Medicare patients only)
Medicare Disability Index (Medicare patients only)
FULL LEGAL DISCLOSURE FORMS IN DETAIL:
Office Hours
Our Regular Schedule
Monday
08:00 am - 06:00 pm
Tuesday
08:00 am - 06:00 pm
Wednesday
08:00 am - 06:00 pm
01:30 pm - 06:00 pm
Thursday
AM by appt only
08:00 am - 12:00 pm
Friday
Saturday
Closed
Closed
Sunday
LOCATION
Find us on the map
Prescott Chiropractic Location
Address
1380 North Acres Road, Suite A,
Prescott, WI 54021
Contact Information
Fax: 715-262-8744
Email: info@prescottchiro.com
