Phone
309 661-9123

Location
1702 Eastland Drive
Suite 205
Bloomington, IL 61704

Hours
M,W,Th,F 8am - 6pm
Saturday 8am - 12pm
Closed Tuesdays & Sundays

  Joseph F. Rogge D.C. Chiropractic Kinesiologist. "An Eastern Approach to Health and Well Being"  
 
             
 
 
 
 

 
New Patient Information

New patients are required to fill out certain forms to facilitate the chiropractic consultation. Please fill out the necessary forms below prior to coming in for your initial appointment.

The following forms are in Adobe PDF format; they require the free Acrobat Reader to view. Click on each to download and view.

 

Patient Health Information Consent Form (HIPPA)

Informed Consent to Chiropractic Care Form

Patient Case History

Pediatric Case History

Required only for pediatric patients (i.e. children below the age of 12)