Please choose the form below that correlates with your condition. You can complete these forms on any computer, tablet or smartphone using Adobe Reader. Once the form is complete you can submit it to us through the secure uploader. PATIENT INFORMATION FORM NEW PATIENT INFORMATION LEFS FORM LEFS. The LEFS is for any client w/ foot, ankle, knee or hip pain NDI FORM The NDI form is for cervical or neck pain ODI FORM The ODI is for back pain DASH FORM The quick DASH is for hand, wrist, elbow, shoulder or arm pain HIPPA PRIVACY PRACTICES HIPPA Privacy for your review PRESCRIPTION PAD The Prescription Pad is for Doctors only BOOK APPOINTMENT Upload your file via our secure form below CHARDON CLINIC MIDDLEFIELD CLINIC ASHTABULA CLINIC
