16 Penn Plaza #22

Bangor, ME 04401

150 Bucksport Rd

Ellsworth, ME 04605

Bangor Clinic:

(207) 947-8077

Ellsworth Clinic:

(207) 667-4678

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Online Forms

Back In Balance Wellness Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.

Adult Forms


New Patient Form

Download & Print Form

Reevaluation Form

Download & Print Form

Update Contact Information

Download & Print Form


Pediatric Forms


New Pediatric Patient Form

Download & Print Form



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Exclusive Offer

New Patients Receive a Free Consultation

Bangor Clinic

Hours of Operation

Monday:

8:30 am-6:30 pm

Tuesday:

7:00 am-5:00 pm

Wednesday:

8:00 am-7:00 pm

Thursday:

7:00 am-7:00 pm

Friday:

8:30 am-2:30 pm

Saturday:

Closed

Sunday:

Closed

Ellsworth Clinic

Hours of Operation

Monday:

8:00 am-6:00 pm

Tuesday:

Closed

Wednesday:

8:00 am-6:00 pm

Thursday:

Closed

Friday:

8:00 am-2:00 pm

Saturday:

Closed

Sunday:

Closed