Save yourself time!

Print the below documents and fill them out. Bring them with you to your first appointment and you can save yourself the time and hassle of filling out paperwork right before your appointment time. 

If you are bringing children under 16, make sure you print the Initial Child Introduction page for them!

If you have questions about the first appointment click or tap "First Visit". 

New Patient Paperwork

Adult Initial Introduction (pdf)


Adult Consultation History (pdf)


Initial Child Introduction (pdf)


Need an appointment?

Just click or tap the button below to fill out the digital contact form so we can set up your New Patient Appointment!

Contact Us

Talk to us!

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Better yet, see us in person!

We love our patients, so feel free to visit during normal business hours.

Peltier Family Chiropractic & Wellness Center

5685 Shull Rd. Dayton, OH 45424 US

Please call us, should you have any questions, comments, or concerns at (937) 236-0464. Fax us at (937)-236-0493


Open today

9:00 am – 5:00 pm

We are closed for lunch time:

Monday and Wednesday - 12:30-3:30

Tuesday and Thursday - 11 - 3:30