Online Forms

Long Island Chiropractic & Physical Therapy, PLLC offers our patient form(s) 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 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.

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!

Download & Print Form


Patient Information and Authorization Form

Download & Print Form


Neck Index

This questionnaire will give the doctor information about how your neck condition affects your every day life.  

Download & Print Form


Back Index

This questionnaire will give the doctor information about how your back condition affects your every day life.  

Download & Print Form


Download the Free Adobe Reader®

Locations

Find us on the map

Smithtown Office
20 Gilbert Ave Smithtown, NY 11787

West Islip Office
786 Montauk Highway West Islip, NY 11795

Office Hours

Our Regular Schedule

Smithtown Office

Monday:

9:00 am-12:30 pm

3:00 pm-6:00 pm

Tuesday:

Closed

Wednesday:

8:00 am-12:30 pm

3:00 pm-6:30 pm

Thursday:

3:00 pm-6:30 pm

Friday:

9:00 am-12:30 pm

Saturday:

8:30 am-11:30 am

Sunday:

Closed

West Islip Office

Monday:

8:00 am-1:00 pm

3:00 pm-7:00 pm

Tuesday:

8:30 am-2:00 pm

Wednesday:

8:30 am-1:00 pm

3:00 pm-7:00 pm

Thursday:

Closed

Friday:

8:00 am-1:00 pm

3:00 pm-6:00 pm

Saturday:

Emergency

Sunday:

Closed

  • "This office is very special. Everybody shows care and compassion and really do the best to help. Thanks."
    Blancalilia M.
  • "As a physician I was a bit reluctant to go to a chiropractor but I knew Larry from the gym and figured I'd give him first shot at it. Totally convinced that there is more to chiropractic medicine than I had believed. Don't even think about it and go."
    Barry Kramer, MD