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