Gardner Schofield Chiropractic: West Bend Chiropractic Office Accepts Most Insurance

New Patient Forms

Gardner Schofield Chiropractic offers our patient forms online so they can be completed 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 forms from the list below that pertain to your visit, print them out and fill in the required information.
  • Bring them with you on your first appointment.

New Patient Intake Form

Completion of this form helps us to understand your health history and the current state of your health. What questions, concerns or goals regarding your health and wellness can we help you with? Let us know — we’re here to help you!­

Natalie K
“I was referred to Dr. FJ by my parents because of issues with headaches, high pressure, and difficulty sleeping. My wife and I were impressed with the upfront and understandable explanation of fee and payment options. The whole staff was... Read More
Steven A
“I was diagnosed with MS in the spring of 2014. In the winter of 2014 I was experiencing a recurring back pain from when I was in high school. I started going to see Dr. FJ in December of 2014... Read More

$47 NUCCA Evaluation

Special Offer* Includes ($445 value):

  • Consultation
  • NUCCA Evaluation
  • Advanced NUCCA Analysis
  • Report 

Try our no obligation, risk-free offer & let’s see if we can fix the underlying cause of your problem.

*may not be valid for Medicare or Medicaid

Schedule Appointment

Call us at 

(262) 334-8188 

or click the button
to schedule your appointment!

Office Hours

Mon:      9am - 12pm   and   3pm - 6pm
Tues:                  -                    3pm - 6pm
Wed:     9am - 12pm   and   3pm - 6pm
Thurs:   9am - 12pm   and   3pm - 6pm
Fri:                            Closed
Sat:                     By appointment
Sun:                          Closed

Connect With Us!

Listen to Our
Health Podcast on iTunes

Schedule Your Appointment with Gardner Schofield Chiropractic
Call (262) 334-8188 or Click Below to Request an Appointment Online.