Ready to become a patient?
- If the appointment is for your child or baby, print and fill out the paper work here (Microsoft Word)
- If the appointment is for an adult, fill out this form (Microsoft Word) along with the symptom survey (PDF)
- Fax or bring in the forms at the time of your appointment. Fax: (937) 596-5109
- Financial Policy
There are 3 things that cause spinal subluxations, Trauma, Toxins, and Emotional Stress. Because of this we will look at your diet to see if there is any way we can help you address the cause of your health concerns. All new patients are required to fill out a symptom survey so we can decide you're a candidate for nutritional counseling. If you need to print off a Symptom Survey Form please click here
We want to see your Children!
Nervous System disturbances can lead to all sorts of health problems. Since we would rather catch problems before obvious symptoms appear, we encourage parents to have their kids checked for subluxations as well. Adjusting children is a safe and effective way to give your child the best chance to grow up health and strong! Print the form below and bring it to your appointment. If you have any questions or concerns about pediatric chiropractic click here (Microsoft Word)