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Frericks Family Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
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.
Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form - 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!
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Member Wellness Registration Form - Optional
This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, or
Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!
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Meet the Doctor
Dr. Jessica Frericks
is a chiropractor who serves Richmond, Spring Grove, Genoa City, Twin Lakes, Hebron, Harvard, Wonder Lake and the surrounding communities in Illinois and Wisconsin. Dr. Frericks is a wife, mother of four daughters and lives in the community. She attended the University of Wisconsin - Madison and then the National University of Health Sciences where she earned a Bachelor of Science in Human Biology and Doctor of Chiropractic degree. Dr. Frericks is also a F.A.S.A. - Fellow of the Acupuncture Society of America, where she received certification in acupuncture. Read More
Services We strive to provide complete care for our patients. Learn more about all the services we provide.
Make An Appointment We will do our best to accommodate your busy schedule. Schedule an appointment today!
Online Forms Our patient forms are available online so they can be completed in the convenience of your own home or office.
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