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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!

Update & New Patient Form (Submit Online) This form is required for all patients who have not been treated in the past 6 months or new to our practice. If you are a minor, this form needs to be submitted by a parent/guardian. You can submit ONLINE. 

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. 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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