859-525-1695

Want to save some time during your first visit to our office? 

Download the New Patient Intake Forms below and fill them out before you come to the office.  

This should save you about 15 minutes or so!

Just follow the directions to get started. 

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    If you don’t have AdobeReader® installed on your computer, Click Here to download it.

  •  Download the necessary forms below.
  •  Fill out as much of the forms as you can online and then print them.
  •  Next, make sure to sign or initial any of the necessary consent forms.
  •  Bring them with you to our office for your first visit.

    Do NOT email or fax these forms to our office.  

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HIPAA Notice of Privacy Practices – Click to Download

Please print off and read this notice of our privacy practices prior to filling out our New Patient Intake Form.

New Patient Intake Form – Click to Download

Please fill out this New Patient Intake Form and then print it off and sign/initial all appropriate fields and then bring it with you to the office for your first visit.

Consent to Treat a Minor Form – Click to Download

If the patient is under 18, please complete this form and accompany the minor to the office.

Basic Health Chiropractic & Rehab, the Office of Dr. Raymond Uhlmansiek, D.C.

5915 Merchants St. 

Florence, KY 41042

859-525-1695

 

 

 

Private or Protected health information should not be disclosed via this website (comments or contact forms, etc.).  This website and or email systems or contact systems may not be secure.  Any information that you transmit via this website or contact forms, etc. is done at your own risk.

You have the right to rescind within seventy-two (72) hours any obligation to pay for services performed in addition to any free or discounted service(s) offered by Basic Health Chiropractic & Rehab, PLLC as per 201 KAR 21:065.

No discounted offers are valid for recipients of Medicare, Medicaid, CHAMPUS, Veterans Affairs, Black Lung, or Indian Health Service Plans or any other Federally funded healthcare programs.

Cities We Service

Florence  Burlington  Independence  Union  Hebron  Elsmere  Erlanger  Edgewood  Oakbrook  Villa Hills  Lakeside Park  Crescent Springs  Crestview Hills  Verona  Walton  Idlewild  Park Hills  Ft. Mitchell  Ft. Wright  Ft. Thomas  Petersburg  Francisville  Taylorsport  Beaverlick  Rabbithash  Bullittsville  Richwood  Devon  Latonia  Fairview  Covington  Morningview  Greendale  Lawrenceburg  Aurora

Zip Codes We Service:  41005  41011  41015  41017  41018  41042  41048  41051  41063  41075  41080  41092  41094  42266  47025  47001