Online Forms

Ready to become a patient?

Call 937-596-6000 or Request an appointment

    Child or Baby                                                                                                                                                Adult

Child Intake form (Microsoft Word)                                                                                                  Adult Intake form (Microsoft Word)

                                                                                                       Symptom Survey (PDF)

                                                                                                             Financial Policy

Consent Form: informed-consent-for-huffer-chiropractic.docx

Fax or bring in the forms at the time of your appointment. 

Fax: (937) 596-5109

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

Get your kids checked too!

baby adjustment

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 baby 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 (ICPA)

Child Patient Information Paper Work (Print then Fill Out)

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Office Hours

Our Regular Schedule

Huffer Chiropractic


7:00 am-12:30 pm

2:00 pm-6:00 pm


7:30 am-12:30 pm

2:00 pm-6:00 pm


7:00 am-12:30 pm

2:00 pm-6:00 pm


7:30 am-12:30 pm

2:00 pm-6:00 pm


7:00 am-12:30 pm

2:00 pm-5:00 pm


7:30 am-12:00 pm