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Request Appointment

(618) 529-5172

Allied Physicians and Rehab of Southern Illinois 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. Completing all of the new patient paperwork that is on this page before you come in for your appointment will save you approximately 15 minutes. 


New Patient Forms

Our purpose is to help you with your health concerns. We need your assistance in doing this and the first step is to tell us about your health concerns by filling out the online forms which can be filled out online at your convenience. PLEASE NOTE!!!! Fill forms out on a laptop or desktop computer. Phones and tablets have been known to cause downloading issues which require you to fill out the paperwork again when you arrive at the office.

PLEASE USE A DESKTOP OR LAPTOP COMPUTER- NO PHONE OR TABLETS.

Click on the link below to begin your new patient paperwork once you have made your appointment. There will be a place for you to "sign" your name at the bottom of the form. Your content is secure. The information will download into our servers. There will be nothing to print out.

https://intake.mychirotouch.com/?clinic=APRO0001


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