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

"From the moment you walk into the office, you are welcomed with a smile and they even manage to remember every single patient's name. They treat you like family and put a lot of emphasis on your care. I started coming to this office when my son was about 4 months old and now at 11 months old, I have seen SO much progress with his neck that I myself started to see Dr D. and I am very grateful to have found such a wonderful place."
Nichole Currie
"From the moment you walk into the office, you are welcomed with a smile and they even manage to remember every single patient's name. They treat you like family and put a lot of emphasis on your care. I started coming to this office when my son was about 4 months old and now at 11 months old, I have seen SO much progress with his neck that I myself started to see Dr D. and I am very grateful to have found such a wonderful place."
Nichole Currie
"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
"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
"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
"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
"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
"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."
Dominick Ranieri
"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
"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 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 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 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
"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. 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
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