Health History Forms

New Patient Special

What to Expect

Being prepared for your appointment will ensure that The Chiropractic Health Center of Glastonbury has all the necessary information to provide the best possible care for you. You may fill out the appropriate forms when you arrive for your first visit, or if you prefer, you may print and fill out any the forms listed above and bring them with you. Additionally, you may wish to prepare a list of questions beforehand so we can address any concerns you have about your health and your chiropractic care.

Patient Forms

Adult Health History
Children’s Health History

Questions about our forms? 

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Family Care

Family Care

Wellness Care

Wellness Care

Sports Performance

Sports Injury

"Great experience! Our whole family goes and we have referred other family members. Dr. Wade is awesome, he listens and wants what is best for his clients."
Kayla Bueno
"The administrative staff and practitioners are all friendly, capable, efficient, and very responsive. In addition, Dr. Keith Wade is knowledgeable, passionate about his craft, patient and thorough in answering questions. As a direct result of all that, my low back, ankles an knees feel much better, I am in less pain, and I am less afraid that my back will keep hurting or "going out." I am very grateful."
Malinda Branson
"I just finished my 30 session program and went over my x-rays with Dr. Wade. The improvement in my scoliosis shown in the x-rays was remarkable and corresponded with the greater mobility and wellbeing I have been experiencing. Dr. Wade is very professional and always willing to answer questions and address specific concerns. I highly recommend him."
Austin Lyons
"They are not only extremely professional and helpful but genuinely care about your well being! In addition, the group is very supportive of the community. I love that they partnered with We Are the Children to donate thousands of dollars worth of toys.
Jocelyn DeMaio
"Dr. Elisa LaFavor has helped me a lot. I was having way too much pain continuously in my shoulders, wrists and hands including problems with range of motion. I am so much better now! She was also able to re-align my back and my posture is much better now. I would highly recommend her. Office staff is great!!!"
Maureen Carroll
"I started my chiropractic journey a few weeks before having my 3rd baby. They were amazing, patient and gentle during the pregnancy. They weren't pushy when I took my time, post pregnancy, to come back. They were amazing with my schedule and did everything to work with me. I felt so comfortable with them that I brought my new born baby and my 3 year old in to get adjusted!"
Candace Lozowski
"I just finished my 30 session program and went over my x-rays with Dr. Wade. The improvement in my scoliosis shown in the x-rays was remarkable and corresponded with the greater mobility and wellbeing I have been experiencing. Dr. Wade is very professional and always willing to answer questions and address specific concerns. I highly recommend him."
Austin Lyons
"I'm a very active individual and lower back pain was getting in the way of activities I love. While my back is still a work in progress, the time spent with Dr. D has been well worth it. I just ran 2 marathons in 2 weeks and these sessions helped me run these races with no back pain."
Matt from mission FITNESS
"Dr. Elisa LaFavor has helped me a lot. I was having way too much pain continuously in my shoulders, wrists and hands including problems with range of motion. I am so much better now! She was also able to re-align my back and my posture is much better now. I would highly recommend her. Office staff is great!!!"
Maureen Carroll
"Dr. D has been providing an integrative approach to the health and well being of my family for over 25 years. He is not only a highly skilled practitioner, but is a compassionate and caring person, not only to his patients but to the community.
Susan Keane
"I strained my lower back a month prior to an Ironman race. I was unable to sleep, walk or sit, never mind continue training as planned. The entire office staff is beyond kind, caring, professional and runs extremely smooth. I was explained every step and procedure, along with a patient education class that really helped me understand what was wrong with my back and steps to fix it. Dr Wade was able to get me sleeping, walking and able to compete in my triathlon. 5 stars for many reasons and would highly recommend."
Dylan Howley
"Such a great experience in understanding and learning how to treat my chronic pain! The office staff is wonderful, informative and empathetic! Dr. D is also invested in making you to your best self! They found a convert here!"
Debby DeMartino
"I love Dr. D and his great staff. I have been going to him for about 16 years and I would gladly recommend him to anyone looking for a chiropractor. He has helped me immeasurably."
Lelaneia Dubay
"I started adjustments for neck, back, and tailbone pain and at the end of the 10 weeks the pain was completely gone. Dr. Wade is kind, funny, and very good at what he does. He brings positive energy into the office every single day and is in a good mood 100% of the time."
Cassandra Kolstad
"Dr. D has been providing an integrative approach to the health and well being of my family for over 25 years. He is not only a highly skilled practitioner, but is a compassionate and caring person, not only to his patients but to the community.
Susan Keane
"I started my chiropractic journey a few weeks before having my 3rd baby. They were amazing, patient and gentle during the pregnancy. They weren't pushy when I took my time, post pregnancy, to come back. They were amazing with my schedule and did everything to work with me. I felt so comfortable with them that I brought my new born baby and my 3 year old in to get adjusted!"
Candace Lozowski
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