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Request an Appointment


Universal Health Institute offers our patient form(s) online so you can complete it in the convenience of your own home or office.

Chiropractic Doctor Patients with (please click on the topic with your main complaint):

Back Pain
Neck Pain

Nutrition Consults (Please note:  This packet includes additional paperwork.  Please make sure to complete everything before your appointment.  Thank you.)

Health Questionnaire Form (NTAF) can be downloaded here.

Children Health Questionnaire (CNNQ) can be downloaded here.

Metabolic Assessment Form (MAF) can be downloaded here.

Stress Strategies Screening Questionnaire can be downloaded here.

Are you expecting? Congratulations!  Pregnant Patients click here.

Medical Doctor Patients click here

Medicare Patients click here.  Please complete this paperwork if Medicare is your Primary or Secondary Insurance.  Please note that Medicare will not pay for certain services.  We will do our best to let you know which services will be covered when you meet with our Account Supervisor after your initial visit. 

Please make sure your paperwork is complete before your visit.  You may call the clinic at 312.266.9090 if you have any questions.  If your paperwork is not complete, your appointment may have to be rescheduled.

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