We will be closed Thursday, 11/26 and Friday, 11/27 for Thanksgiving. Have a safe & happy holiday!

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 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
"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
"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'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
"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
"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 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
"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
"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 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
"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
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