New Patient Paperwork

Rafey Chiropractic & Health Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Fax us your printed and completed form(s) or bring them with you to your appointment.
  • New Patient Health History Form

    Click to Download

  • Treatment of a Minor Form

    Click to Download

  • Auto Injury/Case History Form

    Click to Download

  • Worker's Compensation/Case History Form

    Click to Download

Monday
7:30am - 11:00am
2:00pm - 5:30pm


Tuesday
Closed


Wednesday
7:30am - 11:00am
2:00pm - 5:30pm


Thursday
1:00pm - 4:30pm


Friday
Closed


Saturday & Sunday
Closed

Rafey Chiropractic & Health Center

3377 Compton Rd Suite 130
Cincinnati, OH 45251

(513) 276-4130
Chiropractic Cincinnati OH Highly Recommended Chiro Badge