847-548-4800
Schedule Now

 

Patient Intake Forms

Please click on button below to complete your new patient paperwork for Restorative Health Center.

We ask that you complete all questions (and any drop downs) to the best of your knowledge. Also, at the end to ensure that we receive your forms, on the last page please be sure to sign and click "Submit Intake" on the bottom right. When you successfully submit the forms, you see a "Successful" page with a green check mark. Please contact our office if you have any questions or difficulties with completing these forms.

 

If you are having any difficulty getting to our intake page, please follow this link: 

https://intake.mychirotouch.com/?clinic=RHC0004

Have A Question About Being a New Patient? 847-548-4800

  • Intake Forms

    Download and Print our intake forms.

  • My First Visit

    What to expect at your first visit.

  • Payment Options

    Affordable care for everyone.

  • Gallery

    Photos of Restorative Health Center

karen wilson

I was a patient of Dr. Crystal Surprenant in Maryland for a pulled muscle in the chest that was not healing on it's own. I thought it was going to be a tough one to fix. She got everything loosened up and working again in just a few weeks. She is very personable and wonderful to work with. Sad to see her leave Maryland but her future patients in Illinois are gaining a great Chiropractor!!

Laura Carper

I was a patient of Dr. Crystal's in Maryland. I am so thankful that she treated me because she helped me with a variety of ailments. I especially loved the fact that she was also an athlete and was able to relate to my sports-related injuries. She is an amazing chiropractor and person and Restorative Health Center is lucky to have her!

Howard Krasilovsky

Dr. Crystal Surprenant was my chiropractor in Maryland. She is amazing. Crystal does an excellent job of describing the issues I had and then taking the time to treat them properly. Her treatment helped me maintain the level of physical activity I am accustomed to. I wish her the best.

Lisa Carter

I saw Dr. Crystal Surprenant as a patient in Maryland both for routine pain management as well as a result of a car accident. She is by far my favorite chiropractor that I have worked with to date. Dr. Crystal is one of the rare professionals who make the experience an enjoyable one. She was able to relieve pain that I thought had become a way of life. I never felt rushed while working with her and she always knew who I was without needing to consult a chart or a schedule first. She answered all of my questions without hesitation demonstrating her strong background and medical knowledge as it relates to her practice. Not only does she have a wealth of professional knowledge, Dr. Crystal was very friendly and conversational to where I looked forward to my visits, not only to physically feel better, but to benefit from our conversations. She remembered my medical details as well as information that I had shared personally, being able to connect on both a professional and personal level. Dr. Crystal has my most highest recommendation and I can only hope that my loss will be your gain as a future patient of hers.

Erica Carpio

Dr. Crystal was our family chiropractor for myself and two children who are athletes. We LOVE Dr. Crystal and miss her dearly! My daughter claims she'll never have another chiropractor - ever. :) Dr. Crystal was not only skilled in her therapeutic abilities, but also charismatic, kind and comfortable to be around which is a wonderful balance when having to be in close proximity with a doctor and being left in their hands (literally). Dr. Crystal will be sorely (pun intended!) missed. She made a positive impact on our lives and although we are sad she left the area we are so very pleased that she was able to find a new and promising opportunity. Best of luck Dr. Crystal! Erica, Bianca and Max

New Patient Menu

© 2025 ChiroBuilt. All Rights Reserved.