Patient Forms

Please read this page carefully
and make sure that the required paperwork
arrives before your appointment.

New Patient Forms

Please make sure that the following new patient forms arrive prior to your appointment.

You can fill them out online and then save them OR you can print them out and then fill them out and then scan/save them.   If the appointment is for your child, then ALL parents/guardians must sign the paperwork.

Then, you can email them (thehealthypath@gmail.com) OR fax them (937-444-4385) OR mail them (123 Emmons Place, Mount Orab, Ohio 45154).

  • Copy of official photo identification, such as driver's license or passport.  (If the appointment is for your child, then use your photo ID.)
  • Medicare Form - Medicare requires this form. Please send back only if you have Medicare.  They want to make sure that you know that Dr. Richey does not take Medicare.
  • Diagram - No need to send this diagram back.  We will go over it during your appointment.

Follow-Up Visit Forms

 In order to concentrate more on you and your treatment at your follow-up visits, please make sure that your follow-up forms arrive prior to your appointment.

You can fill them out online and then save them OR you can print them out and then fill them out and then scan/save them. 

Then, you can email them (thehealthypath@gmail.com) OR fax them (937-444-4385) OR mail them (123 Emmons Place, Mount Orab, Ohio 45154).


Thank you very much!


Let food

be thy medicine, 

and medicine 

be thy food.  

~Hippocrates

DANDELION

Herb

Your word

is a lamp

to my feet

and a light

to my path.

~Psalm 119:105

ECHINACEA

Herb

The secret of health

for both mind and body

is not to mourn for the past,

worry about the future,

or anticipate troubles,

but to live in the present moment wisely and earnestly.

~Buddha (paraphrased)

LAVENDER

Herb