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.

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!

1. Download the THREE Forms shown below

Consultation and Health History

HIPPA and Assignment of Care

Informed Consent

Our email is: [email protected]


2. Fill out the forms from your computer 

3. Print and Sign each form

Our email is: [email protected]


Please read carefully 

  • When you arrive at our please call us to let us know you are here. Call (847) 884-8488. 
  • Please wait in your car for further instructions.
  • If we do not answer the phone when you arrive please leave a voice message to let us know you have arrived
  • 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. 

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

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

 


Our office is currently open 

with a reduced schedule

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

HOURS WILL CONTINUE AS DESCRIBED UNTIL FURTHER NOTICE

HORAS CONTINUARÁN COMO SE DESCRIBE HASTA AVISO ADICIONAL

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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Temporary 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