ONLINE FORMS

Allied Health & Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  1. If you do not already have AdobeReader® installed on your computer, click here to download Adobe Reader.

  2. Download the New Patient Form, print out and fill in the required information.

  3. Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Form Includes

  • Page 1 - Basic Patient Info
    Page 2-3 - Health History
    Page 4 - HIPPA Notice of Privacy of Records
    Page 5 - Patient Consent
    Page 6 - Copay discount

Let our expert staff address your health needs, call 216.685.9975 or request an appointment today.