Jerrold L. Solomon D.C., Inc. offers our patient forms online so they can be completed 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 necessary forms, print it out and fill in the required information.
- Fax us your printed and completed forms or bring it with you to your appointment.
- Fax Number: 419-443-8885
New Patient Health History Form (Health Insurance)
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!
New Patient Health History Form (Medicaid)
New Patient Health History Form (Medicare)