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Online Forms

Itasca Health and Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Print Welcome Form

Print Health Profile

Print Pain Chart

Print Quadruple VAS

Print Low Back Pain Questionnaire

Print Neck Pain Questionnaire 

Print DASH Form (arm-shoulder-hand)

Print Knee Questionnaire

Print Shoulder Questionnaire

Print Lower Extremity Functional Scale

HIPPA Privacy Practices



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Location

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Office Hours

Our Regular Schedule

Itasca Office

Monday:

9:00 am-12:30 pm

2:30 pm-6:30 pm

Tuesday:

11:30 am-6:00 pm

Wednesday:

9:00 am-12:30 pm

2:30 pm-6:30 pm

Thursday:

10:00 am-1:00 pm

3:00 pm-6:00 pm

Friday:

9:30 am-12:30 pm

2:30 pm-6:00 pm

Saturday:

By Appt

Sunday:

Closed

Testimonial

  • "He [Dr. Riggio] keeps our family moving. As active as we are, he manages to make sure we are at our best when it really counts."
    Rudolph Julian- Itasca, IL