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

Health Forms
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Family Care

Family Care

Wellness Care

Wellness Care

Sports Performance

Sports Injury

"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
"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 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
"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 came to see Dr. D after both my parents had been coming for quite some time and I began to experience neck pain. All of my visits have been in the midst of COVID-19, something that has turned a lot of places into a frenzy. But instead when coming here it was the opposite. Everything has gone smoothly and I’ve felt safe the entire time. I love coming in and seeing Brooke & Brittany who are always smiling and happy to help. Dr. D helps walk you through everything he is doing so you feel comfortable and are learning as you get adjusted. I would recommend them 100x over."
Caroline Kidney
"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
"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
"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
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