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

"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
"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 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 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
"Dr. Wade and the front office staff are fantastic. The office is friendly and super efficient. I have never had to wait more than 10 minutes to be seen. Dr. Wade got my back feeling better. I’m feeling healthier and have much more energy."
Corey Morrison
"Dr DeFrancesco is an amazing Chiropractor. I have been seeing him for my entire life, and my parents used to drive all the way from Albany NY just to make sure I was able to be seen by Dr D. His genuine desire to make sure you maximize your health is inspiring, and the fact that he clearly practices what he preaches really motivates you. His enthusiasm is infectious and you can't help but leave his office smiling. I would definitely recommend Dr DeFrancesco to everyone."
Dominick Ranieri
"Dr DeFrancesco is an amazing Chiropractor. I have been seeing him for my entire life, and my parents used to drive all the way from Albany NY just to make sure I was able to be seen by Dr D. His genuine desire to make sure you maximize your health is inspiring, and the fact that he clearly practices what he preaches really motivates you. His enthusiasm is infectious and you can't help but leave his office smiling. I would definitely recommend Dr DeFrancesco to everyone."
Dominick Ranieri
"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
"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
"Our family has been clients since 1994 and since 2005, we have been one of his long distance clients moving to New Hampshire! We have continued with monthly adjustments as he is truly The Best of The Best!"
Skip Gilman
"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 had been suffering from hip and leg pain for about year when a respected yoga instructor recommended Dr. D. I attended a Monday night seminar to check the place out and promptly overcame my skepticism. Dr. D is knowledgeable, caring and professional with an office staff that supports his philosophy. This is a state of the art facility providing first class health care. Dr. D has been a true partner in my healing process."
C. Rainey
"I had been suffering from hip and leg pain for about year when a respected yoga instructor recommended Dr. D. I attended a Monday night seminar to check the place out and promptly overcame my skepticism. Dr. D is knowledgeable, caring and professional with an office staff that supports his philosophy. This is a state of the art facility providing first class health care. Dr. D has been a true partner in my healing process."
C. Rainey
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