Please choose the form below that correlates with your condition. Forms need to be saved and uploaded once completed to us through the secure uploader. NEW PATIENT FORM New Patient Information LEFS FORM Patients w/ foot, ankle, knee, or hip pain NDI FORM Patients w/ cervical or neck pain ODI FORM Patients w/ back pain DASH FORM Patients w/ hand, wrist, elbow, shoulder, or arm pain HIPPA PRIVACY HIPPA Privacy for your review PRESCRIPTION PAD For Doctors only BOOK APPOINTMENT Upload your file via our secure form below CHARDON CLINIC MIDDLEFIELD CLINIC ASHTABULA CLINIC
