Wilson Chiropractic Center - Request an Appointment

Request an Appointment .

New Chiropractic Patient?

Don't be nervous... There's a first time for everything!
We have a few options to simplify and expedite the process, and we hope this helps.

First, if you would like to simply call our office and schedule your appointment with our friendly staff we can take care of the details.
Just call our office at 309-343-0028.
They will confirm your name and phone number and ask how you found out about us.

Then you can skip to the Patient Intake Form at the bottom of this page to download and print out if you're able to. Just fill it out at your convenience and bring it to your first day appointment.

Or, perhaps you are comfortable with the whole process and would rather fill out the simple "Contact Information" form below and we will contact you with confirmation of your appointment. Please be sure to include the required contact information and we will take care of the rest. But still download the Patient Intake Form to fill out and bring in if you can.

Your Contact Information: (skip this and go to the Patient Entry Forms
if you're calling in your appointment request)

Name:

* required

Phone Number:

* required

Secondary Phone Number:

Email Address:

* required

Address line 1:

Address line 2:

City, State Zip:

Appointment Details:

Preferred day and time:

* required

Insurance Company:

Please tell us a little about what hurts, or how we can help.:

click here to download our Patient Intake Form