Online Forms


Tri Modern Health offers our patient form(s) online so they can be completed in the convenience of your own home or office.

We Look Forward To Seeing You!


move with balance your local chiropractor






New Patient Paperwork - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Please download the form shown below: 



Forms for New Patients - English  

NEW PATIENT PAPERWORK - ENGLISH


Forms may be filled out on your desktop/computer

Our email is: [email protected]

Note: Additional Paperwork may be required at the time of your visit. 

Please arrive at least 15 minutes prior to your initial visit. 


FORMAS PARA PACIENTES NUEVOS EN ESPANOL: 

Descargue la forma que se muestran a continuación: 

FORMAS PARA PACIENTES NUEVOS - ESPANOL


Please read carefully 

  • If you are experiencing are experiencing any cold or flu like symptoms or feeling ill, please do not come in for your appointment. For more information please visit our Home Page. 
  • Please note our current office hours below. 

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Send us your printed and completed form(s) or bring it with you to your appointment. You may also drop your paperwork off at the office prior to your appointment time/day. 


 


Our office is currently open  

We are Accepting New Patients

We Look Forward To Seeing You!

Please call the office to schedule your appointment for further details and instructions. 

At this time we are not able to accept walk in appointments. 

Monday: 9:00 am-12:00 pm,  3:00 pm-6:00 pm  

Tuesday: 3:00 pm-5:00 pm 

Wednesday:  CLOSED

Thursday:  9:00 am-12:00 pm, 3:00 pm-6:00 pm

Friday: CLOSED

Saturday: 8:30 am-11:00 am


TO LEARN MORE ABOUT OUR RESPONSE TO COVID-19 CLICK HERE


Our Location:

Dr. Hector Martinez, DC

Tri Modern Health

(847) 884-8488

110 W Hillcrest Blvd., Suite 103 Schaumburg IL 60195




REQUEST AN APPOINTMENT

Use the Form Below to Request an Appointment

Location

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Regular Office Hours

Our Regular Schedule (Please call for new patient hours) Hours subject to change or may vary without notice.

Monday:

9:00 am-12:00 pm

3:00 pm-6:00 pm

Tuesday:

3:00 pm-5:00 pm

Wednesday:

CLOSED

Thursday:

9:00 am-12:00 pm

3:00 pm-6:00 pm

Friday:

CLOSED

Saturday:

8:30 am-11:00 am

Closed

Sunday:

Closed