Pediatric Patient Intake Form

For Ages 12 Years And Under

Before completing this form, please schedule your child’s new patient appointment first by calling (773) 348-6908. Once scheduled, click the Get Started button below to complete your new patient paperwork. Thank you and we look forward to seeing you soon!

Monday
8:00am - 12:00pm
1:00pm - 7:00pm


Tuesday
8:00am - 1:00pm
4:00pm - 6:30pm


Wednesday
8:00am - 7:00pm


Thursday
8:00am - 1:00pm
2:30pm - 6:00pm


Friday
8:00am - 1:00pm


Saturday
8:00am - 1:00pm


Sunday
Closed


Accepting Same Day Appointments

Total Balance Chiropractic

3464 N Lincoln Ave
Chicago, IL 60657

(773) 348-6908