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
Phone: 631-360-0170 • 631-724-1991

West Islip Office
Phone: 631-661-1400

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