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Practice Name

Comprehensive Chiropractic & Wellness

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Primary Location
4821 N Damen Ave Unit 1
Chicago, IL 60625
Phone: (312) 658-0658

Office Hours

DayOpenClosed
Monday10:30-12:302-7
Tuesday10:30-12:302-7
Wednesday10:30-12:302-7
Thursday10:30-12:302-7
Friday10:30-12:302-7
SaturdayBy Appt
SundayBy Appt
Main Content

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Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

Exclusive Offer

New Patients $75 For Your First Consultation!

Sign-up using the form or call us at (312) 658-0658 to take advantage of this exclusive offer.

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Client Testimonial

Dr Haynes has done wonders for my way of life.  When I first went to see him my pain was debilitating.  It effected my everyday life.  Dr Haynes took the time to listen to me and discuss his course of treatment.  He truly does put the patent's needs first.  I am now completely out of pain and feeling great.  I would recommend Dr Haynes to anyone.  He is extremely knowledgeable, patient, and a caring.  He is exactly what every doctor should be!

Liz -
Chicago, IL

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Services

We strive to provide complete care for our patients. Learn more about all the services we provide.

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Contact

Comprehensive Chiropractic & Wellness
4821 N Damen Ave Unit 1
Chicago, IL 60625
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Office Hours

DayOpenClosed
Monday10:30-12:302-7
Tuesday10:30-12:302-7
Wednesday10:30-12:302-7
Thursday10:30-12:302-7
Friday10:30-12:302-7
SaturdayBy Appt
SundayBy Appt
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