1801 Crooks Ave

Kaukauna, WI 54130 USA

(920) 766-9411

Open mobile navigation

Online Forms

Haanen-Zilisch-Smith Chiropractic Clinic offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Completing the forms in advance and bringing them with you can help you save time at your initial visit. 

  • 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


Neck Pain Index

Please print and fill out this form along with the new patient form if you have been experiencing neck pain.

Download & Print Index


Low Back Pain Index

Please print and fill out this form along with the new patient form if you have been experiencing low back pain.

Download & Print Index


Headache Index

Please print and fill out this form along with the new patient form if you have been experiencing headaches.

Download & Print Index



Download the Free AdobeReader®

Office Hours

Our Regular Schedule

Dr. Todd Smith - Office Hours

Monday:

8:00 am-1:00 pm

3:30 pm-6:30 pm

Tuesday:

10:00 am-2:00 pm

3:30 pm-6:30 pm

Wednesday:

8:00 am-1:00 pm

3:30 pm-6:30 pm

Thursday:

10:00 am-2:00 pm

3:30 pm-6:30 pm

Friday:

8:00 am-1:00 pm

3:30 pm-5:30 pm

Saturday:

7:00 am-10:00 am

Closed

Sunday:

Closed

Closed

Dr. Don Zilisch - Office Hours

Monday:

7:00 am-11:30 am

12:30 pm-7:00 pm

Tuesday:

7:00 am-11:30 am

12:30 pm-4:00 pm

Wednesday:

10:00 am-11:30 am

12:30 pm-7:00 pm

Thursday:

7:00 am-11:30 am

12:30 pm-4:00 pm

Friday:

7:00 am-11:30 am

12:30 pm-3:00 pm

Saturday:

By Appointment Only

Closed

Sunday:

Closed

Closed

Location

Find us on the map

Testimonials

Reviews By Our Satisfied Patients

  • "Dr Smith has given me relief for my ongoing shoulder issues. I'm always greeted with a smile and treated well by staff."
    Lacey K.
  • "LOVE the personalized attention Dr. Smith gives my family! He is absolutely terrific with my daughter and always asks exactly where the pain is. The receptionists are superb as well! I was referred and have remained a client for years."
    Melissa F.
  • "Very happy with the chiropractic care. The staff is amazing and professional."
    Erica M.
  • "I won't go anywhere else. I refer everyone I know."
    MaryBeth L.

Featured Articles

Read about interesting topics

Newsletter Sign Up

Sign up for more articles