For your convenience, Rai Chiropractic offers our patient intake forms online. Please print and fill them out at home or office before you arrive for your first visit. If you are unable to complete the forms ahead of time, please arrive 10 to 15 minutes early to fill out the forms in the office. 

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out, and fill in the required information.
  • Completed forms can be emailed to us prior to your first visit at info@raichiropractic or bring the printed and completed forms along with you to your first visit.

New Patient Forms – Required

These forms are a crucial first step to your care. They allow the doctors to understand your history and current state of health. This is also an opportunity for you to share any questions you may have, your wellness goals, and a little bit more about you. We look forward to getting to know you! 

Please thoroughly read the attached Consent Form before the appointment time. Do not sign until your appointment with the doctor.

Adults Form – 16 Years of Age or Older – Download & Print Form

Adolescent  Form – 7 to 15 Years of Age or Older – Download & Print Form

Child Form – 3 to 6 Years of Age – Download & Print Form

Infant Form – 0 to 2 Years of Age – Download & Print Form

Download the Free AdobeReader®