Request an Appointment

Back In Line Chiropractic
740 E. Schaumburg Road
Schaumburg, IL 60194
847-781-9595
drlee@backinlinechiropractic.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



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

               

Monday
8:00 - 12:00, 3:00 - 7:00
Tuesday
3:00 - 7:00
Wednesday
9:00 - 12:00, 3:00 - 7:00
Thursday
8:00 - 12:00
Friday
8:00 - 12:00, 3:00 - 7:00
Saturday
By Appointment
Sunday
Closed