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 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
"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
"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
"There is no better place than Chiropractic Health Center, from the moment you step into the office, you are welcomed with a smile and they even manage to remember every patients name. They put a lot of emphasis on your care, you start feeling better with every visit. I would recommend this practice over any other possible treatment/office in the state."
Carlos Vivar-Zuniga
"Dr D is great, he is so patient and attentive to everything you have to say! He has really helped me eliminate pain I have been living with for years. The staff are extremely friendly and welcoming."
Aubrey Sullivan
"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
"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
"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
"Dr D is great, he is so patient and attentive to everything you have to say! He has really helped me eliminate pain I have been living with for years. The staff are extremely friendly and welcoming."
Aubrey Sullivan
"There is no better place than Chiropractic Health Center, from the moment you step into the office, you are welcomed with a smile and they even manage to remember every patients name. They put a lot of emphasis on your care, you start feeling better with every visit. I would recommend this practice over any other possible treatment/office in the state."
Carlos Vivar-Zuniga
"Dr D is great, he is so patient and attentive to everything you have to say! He has really helped me eliminate pain I have been living with for years. The staff are extremely friendly and welcoming."
Aubrey Sullivan
"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
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