Online Forms

Huffer Chiropractic: A Creating Wellness Center offers our patient forms online so you can complete them in the convenience of your own home or office. 

• 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.     Fax number (937)-596-5109.

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Regular New Patient Form

This let’s us know your wellness goals so that we can help you reach your full potential. What questions or concerns regarding wellness can we help you with? Let us know!

Print out the form and then fill out with a pen.

New Patient Form (click here)

New Patient Children Forms -

 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. Adjusting children is a safe and effective way to give your child the best chance to grow up health and strong!

Click here to download and print the Pregnancy History.

Click here to download and print for kids 6 years and older.

Click here to download and print for children 3 months to 5 years.

Click here to download and print for babies 0 to 3 months.

Nutritional Counseling

We now offer nutritional counceling that involves filling out a symptom survey. Please click here to download the form.

Online Membership-

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!