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? 

Just Call – (860) 657-8800

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Family Care

Family Care

Wellness Care

Wellness Care

Sports Performance

Sports Injury

Massage Therapy

Massage Therapy

"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. DeFrancesco 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 have been a patient at the Chiropractic Health Center of Glastonbury for over a decade. I trust Dr. D. and his team implicitly. I would highly recommend this practice."
Kristin Anderson
"I have been a patient at the Chiropractic Health Center of Glastonbury for over a decade. I trust Dr. D. and his team implicitly. I would highly recommend this practice."
Kristin Anderson
"This office was the best experience I have ever had with a doctor. The staff are warm, friendly and accommodating. There was never a long wait to see my doctor. Dr. Wade helped with some long term lower back pain that I thought I would have to live with, however after going through the treatment process, I'm happy to say i'm no longer in any pain. I would highly recommend the office to anyone."
Chris Faulkner
"I would highly recommend this practice for all chiropractic needs. The staff here are amazing. Everyone is super nice and always bringing positive energy with them. The doctors are really knowledgeable and take the time to help you throughout your care."
Timothy Donovan
"Dr D. is extremely attentive to patient's needs and always takes the time to answer questions. The entire staff is always so friendly and greets each person with a smile. I highly recommend them!"
Diane Jachimowicz
"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. DeFrancesco 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
"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
"Both my parents and I see Dr D. I've been going for the past 2 years. They have a great family program. The staff is professional and welcoming. Dr D is always great with all my chiropractic issues."
Payton Lussen
"I have been to Dr. D multiple times for back pain and each time, he has helped me get rid of the pain entirely! I encourage anyone struggling with pain, or just looking for a way to stay healthy overall, to give his office a call. He is an amazing person who truly cares about his patients!
Jackie Brousseau Post
"Both my parents and I see Dr D. I've been going for the past 2 years. They have a great family program. The staff is professional and welcoming. Dr D is always great with all my chiropractic issues."
Payton Lussen
"I have been to Dr. D multiple times for back pain and each time, he has helped me get rid of the pain entirely! I encourage anyone struggling with pain, or just looking for a way to stay healthy overall, to give his office a call. He is an amazing person who truly cares about his patients!
Jackie Brousseau Post
"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. During each session, he gave me tips on faster healing and lifestyle changes I could make to help in the future."
Cassandra Kolstad
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