woman with outstretch arms

Online Forms

Pank Chiropractic Relief and Wellness Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.

Informed Consent and Terms of Acceptance

Consent for Minor

HIPPA Form

New Patient Form

Neck and Back Index



Download the Free AdobeReader®

Location

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Office Hours

Monday:

8:00 am-5:30 pm

Tuesday:

12:00 am-5:30 pm

Wednesday:

8:00 am-5:30 pm

Thursday:

8:00 am-5:30 pm

Friday:

8:00 am-12:00 pm

Saturday:

Closed

Sunday:

Closed

Testimonials

Reviews By Our Satisfied Patients

  • "I had foot pain from standing on concrete all day. I got my feet scanned using the Foot Leveler Orthotic system and now wear my custom orthotics daily with minimal foot pain. These custom orthotics are absolutely worth every penny!"
    Dean Sonsalla, Arcadia, WI.
  • "Quinn (4 years old) had some incidents of wetting the bed after she had a long period of dry nights. Three adjustments and Quinn has been doing great!"
    Erin Paulson, Ettrick, WI
  • "I had constant foot pain from standing on concrete all day long. I had almost immediate relief after wearing Foot Leveler orthotics."
    Garret Zwiefelhofer, Bloomer,WI