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Rauch Chiropractic Wellness Center offers our patient form(s) online so they can be completed it 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 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!

Download & Print Adult Form
Download & Print Child Form

NOTICE OF PRIVACY PRACTICES- Required

Download & Print Privacy Policy

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

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John M. Rauch, D.C.

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RauchChiro : Dr. Rauch is offering a FREE Auto Injury Relief Guide for Palm Harbor residents. http://t.co/eIdZR2V http://t.co/c5cl2dp 5 days ago · reply · retweet · favorite

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RauchChiro Visit a Leading Chiropractor for a Sports Injury: Hello everyone in Palm Harbor, Florida, I am the number one ch... http://t.co/WAdfbAS 6 days ago · reply · retweet · favorite

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RauchChiro : Relieve your neck pain without drugs or surgery http://t.co/lfbdVyD http://t.co/pt529q4 13 days ago · reply · retweet · favorite

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RauchChiro Annual Birthday Party: Title: Annual Birthday PartyLocation: Rauch Chiropractic Wellness CenterDescription: RAUC... http://t.co/mdhs5qd 13 days ago · reply · retweet · favorite