Online Forms

Chiropractic Place Family Wellness Centers offers our patient form(s) online so they can be completed 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 Intake Form

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! A photo I.D. is required at time of check-in at your first appointment. 

Download & Print Form


Pediatric New Patient Intake Form (Ages 6 & under)

Download & Print Form



Download the Free Adobe Reader®

Locations

Find us on the map

Office Hours

Our Regular Schedule

Onalaska - (608) 783-7735

Monday:

7:00 am-6:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

7:00 am-6:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Sparta - (608) 269-4511

Monday:

7:00 am-6:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

7:00 am-6:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Holmen - (608) 526-4628

Monday:

7:00 am-6:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

7:00 am-6:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

La Crosse - (608) 785-2225

Monday:

8:00 am-6:00 pm

Tuesday:

8:30 am-12:00 pm

Wednesday:

8:00 am-6:00 pm

Thursday:

2:00 pm-5:30 pm

Friday:

7:00 am-1:00 pm

Saturday:

Closed

Sunday:

Closed