New Patient Forms

As a new patient, there are a few forms you can access before your first visit!


Save Time on Your First Visit!

If you are a new patient to our clinic, you may save time by completing the following forms prior to arriving for your appointment. All forms are in PDF format.

Confidential Patient Information Form

Patient Survey Form

How We Can Help

  • Chiropractic Care

    Aches, pains and disease are signs that the body isn't working properly. We will show you that chiropractic is safe, proven, and works!
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  • Applied Kinesiology

    As a scientific method of diagnosis utilizing specialized muscle testing to evaluate the major systems in your body, Applied Kinesiology helps determine precise treatments for your condition.
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  • Lymphatic Compression Massage

    Regular lymphatic drainage massage can assist in improving your body’s ability to protect itself, remove excess toxins, and unlock fat from the fat cells.
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  • Designed Clinical Nutrition

    Our doctors offer nutritional counseling. This program is a specifically designed nutrition program based on your body, to aid in healing itself.
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  • Footbath Detox Unit

    In addition to our Detoxification programs, we also recommend footbath detox unit treatments at our Bainbridge clinic. Contact us to find out more.
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  • Sauna Dome & Biomat Technology

    Deep penetrating heat that detoxifies and revitalizes the cells
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From Our Patients

ACID REFLUX/INDIGESTION: Before I started my program with Chagrin Natural Health, I had a bloated stomach, diarrhea, pretty bad heartburn and acid reflux. Now I’m feeling much better overall. I no longer have a bloated stomach or diarrhea. Sometimes I still get acid reflux and even less often heartburn, but it’s much milder now than it used to be. I had been taking 2 Prevacid for my problems since 7/21/10, and have recently been able to stop taking it because there is no longer a need!

— K.S.