Request an Appointment

Midtown Chiropractic Clinic
444 N. Henderson Street
Galesburg, IL 61401
309-344-4030
info@illinoischiropractic.com
*Indicates a Required Field

Please view our office hours and then fill in the following form to request an appointment. You will receive a confirmation call to verify, before any appointment is scheduled.

*First Name
*Last Name
*Phone
format: XXX-XXX-XXXX
*Email Address


Date and Hour for Requested Appointment

*Select Hour *AM/PM

*Please tell us if you are a current patient, or are requesting to become a new patient.
I am a current patient at your office
I am looking to make an appointment to become a new patient


Optional Short Comments or Message

For verification purposes, please type in the numbers and letters that you see below then press the Send Request button.

NOTE: You do not have a scheduled appointment until we can call you and verify this appointment request.

               

Monday
8:30 - 5:30
Tuesday
BY APPT. ONLY
Wednesday
8:30 - 5:30
Thursday
8:30 - 5:30
Friday
8:30 - NOON
Saturday
CLOSED
Sunday
CLOSED