20 Gilbert Ave #201, Smithtown, NY 11787, United States

786 Montauk Hwy, West Islip, NY 11795, United States

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®

CONTACT US TODAY

We look forward to hearing from you

Smithtown

20 Gilbert Ave #201,
Smithtown, NY 11787, United States

(631) 724-1991

Our Team

DON WALLACE, D.C.
GERARD J. SMITH, D.C.
CHRISTINA DALRYMPLE, N.P
DANNA BALLIS, DPT
STEPHANIE COSTIGLIOLA, LMT


West Islip

786 Montauk Hwy,
West Islip, NY 11795, United States

(631) 661-1400

Our Team

LAWRENCE OPISSO, D.C.
GERARD J. SMITH, D.C.
CHRISTINA DALRYMPLE, N.P
KIERAN SHANNON, LMT
CHRISTOPHER GRABOWSKI, P.T.


Office Hours

Smithtown Office

Monday

8:00 am - 6:00 pm

Tuesday

2:00 pm - 6:00 pm

Wednesday

8:00 am - 6:00 pm

Thursday

Closed

Friday

8:00 am - 6:00 pm

Saturday

Closed

Sunday

Closed

West Islip Office

Monday

3:00 pm - 6:30 pm

Tuesday

10:00 am - 5:30 pm

Wednesday

9:30 am - 1:00 pm

Thursday

12:00 pm - 6:30 pm

Friday

10:00 am - 3:30 pm

Saturday

Closed

Sunday

Closed

Smithtown Office

Monday
8:00 am - 6:00 pm
Tuesday
2:00 pm - 6:00 pm
Wednesday
8:00 am - 6:00 pm
Thursday
Closed
Friday
8:00 am - 6:00 pm
Saturday
Closed
Sunday
Closed

West Islip Office

Monday
3:00 pm - 6:30 pm
Tuesday
10:00 am - 5:30 pm
Wednesday
9:30 am - 1:00 pm
Thursday
12:00 pm - 6:30 pm
Friday
10:00 am - 3:30 pm
Saturday
Closed
Sunday
Closed