Request an Appointment

Active Living Chiropractic
2259 Randall Rd.
Carpentersville, IL 60110
847-551-4410
info@activelivingchiro.org
*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

9 AM to 12 PM
3 PM to 7 PM

Tuesday

 3 PM to 6 PM
**Free Health Care Classes**
Held every Tuesday!  Contact us to reserve your seat!

Wednesday

 9 AM to 12 PM
3 PM to 7 PM

Thursday
CLOSED
Friday
 9 AM to 12 PM
3 PM to 7 PM
Saturday
CLOSED
Sunday

 CLOSED