Become a New Patient With Us

Save 20 Minutes on Your First Visit

At Kaiser Chiropractic, S.C. we offer our patient forms online, so that they can be completed in the convenience of your own home or office.
  • Click on the necessary link(s) below
  • Print out the forms and fill in the required information
  • Bring in your printed and completed forms for your first appointment
  • Please bring with a list of all supplements and medications you are taking
  • All of the information that you provide to us is completely confidential
If you would like to fax us your completed forms before your first appointment, call us at
262-248-4001. Our fax number is 262-248-4069.

New Patient Adult Forms

Additional Forms for Conditions

New Patient Children Forms

Returning Patient Forms

Massage Therapy Forms

Health on a Budget

At Kaiser Chiropractic, S.C. we know that "Health is your Greatest Wealth" and we are convinced that an investment in your health now is far less expensive than recovering your health later in life. Our office would like to encourage you to take your health very seriously.  We believe in the value of wellness care for you and your family. To learn more about insurance or our payment options for chiropractic and wellness care, you can call us directly at 262-248-4001.

Insurance - Most insurance plans are accepted at our chiropractic office. Our office participates in most insurance plans including auto accident, workers compensation, personal injury, and Medicare. Since there are many plans and coverage varies widely, call us today to find out what your chiropractic benefits may be. Also, as a service to you, our Insurance Specialist will verify and explain your benefits.

No Insurance - If you have no insurance or do not have chiropractic benefits, there is still a way for you to receive the care you need. Flexible payment plans can be arranged and we will work with you one on one to find a plan that will best fit your needs. Many patients pay directly for care, as they discover chiropractic to be extremely cost-effective and affordable. For these patients, chiropractic care is often cheaper and more effective than alternative pain treatments such as pain medications or invasive surgery.  

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