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Our Location

Primary Location

2 Northfield Plz, Ste 204

570 Frontage Rd

Northfield, Illinois 60093 United States

(847) 657-8686

Online Forms

Richart Chiropractic and Functional Medicine 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!

Please download and print all 4 forms.

New Patient Form

Download & Print Form

Financial Policy

Download & Print Form

Patient Health Information Form (HIPAA)

Download & Print Form

Functional Rating Index (Pain Scale)

Download & Print Form



Download the Free AdobeReader®