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

  • Some forms require AdobeReader®. If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Submit forms online, fax or email. Fax to Green: 330.899.0527 or Norton: 330.227.7108. Email to Green: ragongreen@gmail.com or Norton ragonnorton@gmail.com.*
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with today? This is necessary for each patient. If you are unable to submit online or print this form, please arrive 10 minutes prior to your scheduled appointment and a form will be provided for you. We look forward to serving you!

*Use a Computer. A mobile device will not allow you to submit electronically.

New Patient Form* (Submit Online Only from a Laptop or Desktop Computer) This form is required for all patients who have not been treated in the past 3 years or new to our practice. If you are a minor, this form needs to be submitted by a parent/guardian. You can submit ONLINE. *Use a Computer. A mobile device will not allow you to submit electronically.

Update & New Patient Form (Print Only) This form is required for all patients who have not been treated in our office in the past 6 months. If you have not been treated in the last 3 years, please fill out the above New Patient Form. You can print, fax or email* your submission.

*Email may not be secure. Print, fax and filling out in our office are alternative options.




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