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New Patient Paperwork

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complete your intake Today

Completing your new patient paperwork ahead of your appointment saves you time when you arrive and helps to ensure that your first visit is seamless and convenient. Click the link below to instantly access the digital intake form that relates to your appointment. From start to finish, this shouldn’t require more than 10 minutes of your time.

If you are unable to complete your digital intake form, please arrive for your appointment 15-minutes early to complete a paper copy in the office.

Your New Patient Paperwork Covers the Critical Information Required to Treat You, Including:

    • Your medical history
    • Pain symptoms
    • Any accidents or injuries you may have experienced
    • Your habits & lifestyle
    • Family history
    • Other information required to give us a full picture of your health and treatment goals

Which Form should you complete?

Select the form that best relates to the service you are interested in. Got questions? Connect with us! (815) 436-1988

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Love Dr. Jesse!!!! He is compassionate, understanding, and flexible!!! I’ve been seeing him for over three years for my chronic upper back/neck pain and he knows exactly how to help you feel better fast. I recently moved and I still drove 30 minutes to see Dr. Jesse because my back has been really flared up for the last few days… After some time on the traction table and a few expert adjustments I can stand up straight again!! Thank you Dr. Jesse!!!!!

5
Samantha Aspel
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I am so very happy that I found Dr. Jesse Lang online! My husband was having some back pain and we have always used a natural approach to healing over conventional. Dr. Lang got to the root of his problem and felt better after his first visit. I too was having pain in my hip and started going for weekly visits and I feel so much better! Dr. Lang listens to all your concerns and helps to find the answers to alleviate your pain & discomfort. We always refer Dr. Lang to friends and family! Awesome!

5
Deb Hibben
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Dr. Jesse Lang at Shorewood Elite Healthcare is the BEST! You will not be disappointed. I have many health issues and he has relieved so much of my pain. I was going to a pain Dr. and getting shots in my back, hip, leg with no success. Started going back to Dr. Jesse and with a few treatments feel so MUCH better. Plus he has a great personality, very upbeat, always a pleasure to be in his company.

5
Deborah Bucher
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Love Dr. Jesse and staff! Always friendly and super accommodating! Dr. Jesse works hard to make sure you always leave feeling better than when you walked in. I never feel rushed, as he always takes the time to talk. He really gets to know his patients and treats them like family. As an added bonus, there are incredible massage chairs to sit in while you wait for your adjustment! I wouldn’t go anywhere else.

5
Kelly Cisco
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Dr Jesse is The best!! We have been with him for years I don’t trust anybody else with my family! He is a very caring and compassionate person and is more like family than a Dr. We love Dr Jesse.

5
Sherri Tate
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Dr. Jesse is the best! We’ve been coming here for 3 years and we love it!

5
Andy Sharik
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Great overall everything!! Service excellent, professionalism A1!! Excellent Excellent!!!

5
LaToya Starks
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Dr. Jesse & staff are the BEST! Dr. Jesse is caring and compassionate. He remembers all the little details and makes you feel like a friend. He listens and never makes you feel rushed. The tools available in his office while waiting are also a nice perk. His staff is very responsive and so nice. Can’t recommend them enough.

5
Kayli Hinson

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