Online Forms

Please fill out our patient forms before your first visit.  We will need your patient information, insurance information, accident information, and more.

  • If you do not already have AdobeReaderĀ® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it 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? Let us know!

Patient form 1

Patient form 2

Most insurance accepted

We accept Ohio Medicaid, Medicare, personal injury cover, and Worker's Compensation.

Start feeling better

  • Back pain
  • Neck Pain
  • Shoulder Pain
  • Leg Pain


Booth Chiropractic

Address

55741 National Road
Bridgeport, OH 43912

Office Hours

Monday  

8:00 am - 12:00 pm

2:00 pm - 6:00 pm

Tuesday  

9:00 am - 12:00 pm

2:00 pm - 5:00 pm

Wednesday  

8:00 am - 12:00 pm

2:00 pm - 6:00 pm

Thursday  

Closed

Friday  

8:00 am - 12:00 pm

2:00 pm - 6:00 pm

Saturday  

9:00 am - 12:00 pm

Sunday  

Closed

CONTACT US TODAY

We look forward to hearing from you