New Patient Forms

Route 28 Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

If you do not already have AdobeReader® installed on your computer, Click Here to download.

Download the form(s), print it out and fill in the required information.

Bring your completed forms with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with?

Download & Print Form

If you still can't download the form using the link above, please try to download the form below.

Patient History for Dr Walther


Office Hours
Monday 9am-7pm
Tuesday 10am-2pm
Wednesday 9am-7pm
Thursday By Appt.
Friday 9am-7pm
Saturday By Appt.
Sunday Closed

Call 513-575-5444 Now To Schedule A FREE Consultation

Office Location: Milford

1240 State Route 28
Suite B
Milford, OH 45150

Located just west of Branch-Hill Guinea Pike 
On State Route 28 in Plaza with Grammas Pizza

View Photos & Map

Insurance and
Managed Care Plans
Accepted 

• ACN • Anthem Blue Cross/ Blue Shield • Aetna • Choice Care/ Humana • Humana • Health Span • Medical Mutual of Ohio • Medicaid • Medicare • United Healthcare • Workers’ Compensation


Car Accident?
Get Help With
Your Pain Here
Injured At Work?
We Are Here
To Help You
Headaches?
Let Us Help You
Ease The Pain
Neck & Back Pain
Find Out How We
Can Help Here