Chardon 440-286-1007 Middlefield 440-632-1007


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.

Please download your desired file.

Patient Information Form.

LEFS. The LEFS is for any client w/ foot, ankle, knee or hip pain.

NDI. The NDI form is for cervical or neck pain.

ODI. The ODI is for back pain.

DASH. The quick DASH is for hand, wrist, elbow, shoulder or arm pain.

HIPPA Privacy Practices

Prescription Pad. The Prescription Pad is for Drs only.

Upload your file via our secure form below.

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