Online Forms

Jeske Chiropractic Clinic offers our patient form(s) online so they can be completed it 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.

New 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


Complimentary Initial Consultation (Does Not Include Adjustment, Exam or X-Rays).

Sign-up using the form or call us at 440-882-3200 to take advantage of this exclusive offer.

Office Hours

Monday:

8:00 am - 12:00 pm

2:00 pm - 6:00 pm

Tuesday:

8:00 am - 12:00 pm

2:00 pm - 6:00 pm

Wednesday:

8:00 am - 12:00 pm

2:00 pm - 6:00 pm

Thursday:

Closed

Closed

Friday:

8:00 am - 12:00 pm

2:00 pm - 6:00 pm

Saturday:

Closed

Closed

Sunday:

Closed

Closed

Locations

Testimonials

Reviews By Our Satisfied Patients

  • "I have been a patient of Dr. Jeske's for years. I cannot begin to explain how much he has helped me. The staff is wonderful and always friendly. If you are on the fence about scheduling an appointment...do it!!! You will not be sorry!!!"
    Jeannie O'Grodnick / Facebook
  • "The staff is amazing! They are super friendly. I always leave feeling better thanks to Dr. Jeske. The best part is the massage table before being adjusted! Haha."
    Samantha Bieda / Facebook
  • "Dr. Jeske is a miracle worker! He is great at explaining how everything is connected and know which areas to work on and he can even tell before you tell him that you have a headache. AWESOME! Love the whole staff!"
    Kelly Shedlock / Facebook

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