New Patient Paperwork

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

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.
  • New Patient Paperwork

    Click to Download

  • DCPC Privacy Practice

    Click to Download

OFFICE HOURS


Monday
8:00am - 4:30pm


Tuesday
8:00am - 4:00pm


Wednesday
8:00am - 4:30pm


Thursday
Closed


Friday
8:00am - 2:30pm


Saturday & Sunday
Closed

Smith Chiropractic and Occupational Medicine

14015 Jamestown Rd
Breese, IL 62230

(618) 526-7732