{"id":533,"date":"2019-07-01T03:41:07","date_gmt":"2019-07-01T03:41:07","guid":{"rendered":"https:\/\/odellfamilychiro.com\/?page_id=533"},"modified":"2022-04-04T18:29:57","modified_gmt":"2022-04-04T18:29:57","slug":"online-forms","status":"publish","type":"page","link":"https:\/\/odellfamilychiro.com\/new-patient-center\/online-forms\/","title":{"rendered":"Online Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"533\" class=\"elementor elementor-533\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-195a87b5 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"195a87b5\" data-element_type=\"section\" data-settings=\"{&quot;shape_divider_bottom&quot;:&quot;mountains&quot;}\">\n\t\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" data-negative=\"false\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 1000 100\" preserveAspectRatio=\"none\">\n\t<path class=\"elementor-shape-fill\" opacity=\"0.33\" d=\"M473,67.3c-203.9,88.3-263.1-34-320.3,0C66,119.1,0,59.7,0,59.7V0h1000v59.7 c0,0-62.1,26.1-94.9,29.3c-32.8,3.3-62.8-12.3-75.8-22.1C806,49.6,745.3,8.7,694.9,4.7S492.4,59,473,67.3z\"\/>\n\t<path class=\"elementor-shape-fill\" opacity=\"0.66\" d=\"M734,67.3c-45.5,0-77.2-23.2-129.1-39.1c-28.6-8.7-150.3-10.1-254,39.1 s-91.7-34.4-149.2,0C115.7,118.3,0,39.8,0,39.8V0h1000v36.5c0,0-28.2-18.5-92.1-18.5C810.2,18.1,775.7,67.3,734,67.3z\"\/>\n\t<path class=\"elementor-shape-fill\" d=\"M766.1,28.9c-200-57.5-266,65.5-395.1,19.5C242,1.8,242,5.4,184.8,20.6C128,35.8,132.3,44.9,89.9,52.5C28.6,63.7,0,0,0,0 h1000c0,0-9.9,40.9-83.6,48.1S829.6,47,766.1,28.9z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1c9bbb50\" data-id=\"1c9bbb50\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2012199b elementor--v-position-top elementor--h-position-center elementor-widget elementor-widget-slides\" data-id=\"2012199b\" data-element_type=\"widget\" data-settings=\"{&quot;navigation&quot;:&quot;none&quot;,&quot;autoplay&quot;:&quot;yes&quot;,&quot;pause_on_hover&quot;:&quot;yes&quot;,&quot;pause_on_interaction&quot;:&quot;yes&quot;,&quot;autoplay_speed&quot;:5000,&quot;infinite&quot;:&quot;yes&quot;,&quot;transition&quot;:&quot;slide&quot;,&quot;transition_speed&quot;:500}\" data-widget_type=\"slides.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-swiper\">\n\t\t\t<div class=\"elementor-slides-wrapper elementor-main-swiper swiper\" dir=\"ltr\" data-animation=\"fadeInUp\">\n\t\t\t\t<div class=\"swiper-wrapper elementor-slides\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-repeater-item-2bfbb74 swiper-slide\"><div class=\"swiper-slide-bg\" role=\"img\"><\/div><div class=\"swiper-slide-inner\" ><div class=\"swiper-slide-contents\"><div class=\"elementor-slide-heading\">Online Forms<\/div><div class=\"elementor-slide-description\">O'Dell Family Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.<\/div><\/div><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-3608aae elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3608aae\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-afde157\" data-id=\"afde157\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e439a5c elementor-widget elementor-widget-heading\" data-id=\"e439a5c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Finish Your Forms Without Having To Come In<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-eb2314e elementor-widget elementor-widget-html\" data-id=\"eb2314e\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<!-- add this tag where you would like the form to appear --> <script charset=\"utf-8\" src=\"https:\/\/cdn.reviewwave.com\/js\/reviewwave.js\" data-id=\"488986218c737f42429eaf7b9c955d9556d0\"><\/script>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-f64d6d4 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f64d6d4\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-82bed89\" data-id=\"82bed89\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a37c15e elementor-widget elementor-widget-heading\" data-id=\"a37c15e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">ONLINE FORMS<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2aaccfc elementor-widget elementor-widget-text-editor\" data-id=\"2aaccfc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul><li>If you do not already have AdobeReader\u00ae installed on your computer,\u00a0<a title=\"Download the free AdobeReader\u00ae\" href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\" target=\"_blank\" rel=\"noopener\">Click Here<\/a>\u00a0to download.<\/li><li>Download the necessary form(s), print it out and fill in the required information.<\/li><li>Fax us your printed and completed form(s) or bring it with you to your appointment.<\/li><\/ul>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7b83840 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"7b83840\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-inner-section elementor-element elementor-element-6b9e718 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6b9e718\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-62fa5c4\" data-id=\"62fa5c4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-92bdb97 elementor-widget elementor-widget-heading\" data-id=\"92bdb97\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\"><strong>Health Questionnaire - Required<\/strong>\n<br>\nThis lets Dr. O'Dell know more about you and where you can fill out additional information pertaining to your visit.\n<br>\n<a style=\"color:#0073aa;\" href=\"\/wp-content\/uploads\/2019\/07\/Chiropractic_Health_Questionnaire_June_2016.pdf\" target=\"_blank\" onclick=\"_gaq.push(['_trackEvent','Download','PDF',this.href]);\" rel=\"noopener\">Download &amp; Print Form<\/a><\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-a6ed36f\" data-id=\"a6ed36f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-58bed9f elementor-widget elementor-widget-heading\" data-id=\"58bed9f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\"><strong>New Patient Family Health History Form - Required<\/strong>\n<br>\nThis lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!\n<br>\n<a style=\"color:#0073aa;\" title=\"NewPatientForms\" href=\"\/wp-content\/uploads\/2019\/07\/Family_Healthy_History_June_2016.pdf\" target=\"_blank\" onclick=\"_gaq.push(['_trackEvent','Download','PDF',this.href]);\" rel=\"noopener\">Download &amp; Print Form<\/a><\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-3c178dd elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"3c178dd\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-inner-section elementor-element elementor-element-8b90994 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8b90994\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-e800d63\" data-id=\"e800d63\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ea86322 elementor-widget elementor-widget-heading\" data-id=\"ea86322\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\"><strong>Patient Consent Form (HIPAA Compliance)- Required<\/strong>\n<br>\nThis lets us know of your rights as a patient and, in particular, the proper care and handling of your medical and personal information as per the federal Health Insurance Portability and Accountability Act (HIPAA)\n<br>\n<a style=\"color:#0073aa;\" title=\"PatientConsentForm_HIPAA\" href=\"\/wp-content\/uploads\/2019\/07\/Patient_Consent_Form_Oct_10_2016.pdf\" target=\"_blank\" onclick=\"_gaq.push(['_trackEvent','Download','PDF',this.href]);\" rel=\"noopener\">Download &amp; Print Form<\/a><\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-5a530c7\" data-id=\"5a530c7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-18d77ea elementor-widget elementor-widget-heading\" data-id=\"18d77ea\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\"><strong>Informed Consent to Care Form - Required<\/strong>\n<br>\nThis form lets us know that you are aware of the information that the Doctor can share your treatment options with you so you can make the best decision for yourself.\n<br>\n<a style=\"color:#0073aa;\" title=\"PatientConsentForm_HIPAA\" href=\"\/wp-content\/uploads\/2019\/07\/Informed_Consent_to_Care.pdf\" target=\"_blank\" onclick=\"_gaq.push(['_trackEvent','Download','PDF',this.href]);\" rel=\"noopener\">Download &amp; Print Form<\/a><\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-851ec98 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"851ec98\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-inner-section elementor-element elementor-element-153ea3c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"153ea3c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-1b96f33\" data-id=\"1b96f33\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b1e0c8f elementor-widget elementor-widget-heading\" data-id=\"b1e0c8f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\"><strong>Child Health Survery<\/strong>\n<br>\nIn order for us to render pediactric chiropractic services, we will need you to fill out the form below. This forms provides us with information needed to better treat your child. Please call if you have any questions!\n<br>\n<a style=\"color:#0073aa;\" title=\"PatientConsentForm_HIPAA\" href=\"\/wp-content\/uploads\/2019\/07\/Child_Health_Survey.pdf\" target=\"_blank\" onclick=\"_gaq.push(['_trackEvent','Download','PDF',this.href]);\" rel=\"noopener\">Download &amp; Print Form<\/a><\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-f6056af\" data-id=\"f6056af\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7fcc96e elementor-widget elementor-widget-heading\" data-id=\"7fcc96e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\"><strong>Neck Pain and Back Pain Disability Index Forms<\/strong>\n<br>\nIf you are experiencing pain in your neck or low back, print and fill out the below forms and bring them to your chiropractic visit.\n<br>\n<a style=\"color:#0073aa;\" title=\"PatientConsentForm_HIPAA\" href=\"\/wp-content\/uploads\/2019\/07\/ADL_Neck.pdf\" target=\"_blank\" onclick=\"_gaq.push(['_trackEvent','Download','PDF',this.href]);\"\n rel=\"noopener\">Download &amp; Print Neck Pain Form<\/a>\n<br>\n<a style=\"color:#0073aa;\" title=\"PatientConsentForm_HIPAA\" href=\"\/wp-content\/uploads\/2019\/07\/ADL_Low_Back.pdf\" target=\"_blank\" onclick=\"_gaq.push(['_trackEvent','Download','PDF',this.href]);\"\n rel=\"noopener\">Download &amp; Print Low Back Pain Form<\/a><\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-1e27837\" data-id=\"1e27837\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2e384ae elementor-widget elementor-widget-text-editor\" data-id=\"2e384ae\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div data-elementor-type=\"section\" data-elementor-id=\"805\" class=\"elementor elementor-805\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-inner-section elementor-element elementor-element-226a67aa elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"226a67aa\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-79012162\" data-id=\"79012162\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-298156a4 elementor-widget elementor-widget-heading\" data-id=\"298156a4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">NEW PATIENT SPECIAL<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cf6ccbe eael-gravity-form-button-custom elementor-widget elementor-widget-eael-gravity-form\" data-id=\"cf6ccbe\" data-element_type=\"widget\" data-widget_type=\"eael-gravity-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t            <div class=\"eael-contact-form eael-gravity-form labels-hide title-description-hide eael-contact-form-align-default\">\n                                    <div class=\"eael-gravity-form-heading\">\n                                                    <h3 class=\"eael-contact-form-title eael-gravity-form-title\">\n                                SPINAL EVALUATION SCREENING FOR $37!                            <\/h3>\n                                                                            <div class=\"eael-contact-form-description eael-gravity-form-description\">\n                                Fill out your name, email address, and phone number below to receive our New Patient Special!                            <\/div>\n                                            <\/div>\n                                <script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper chiro_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_1' ><form method='post' enctype='multipart\/form-data'  id='gform_1' class='chiro gform_legacy_markup' action='\/wp-json\/wp\/v2\/pages\/533' >\n                        <div class='gform_body gform-body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_1\" class=\"gfield gfield_contains_required field_sublabel_hidden_label field_description_below hidden_label gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first' >\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_1_1_3' class='hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last' >\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_1_1_6' class='hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_4\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible\" ><label class='gfield_label' for='input_1_4' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_1_4' type='text' value='' class='large'  placeholder='10 Digit Phone # (Incl. Area Code)' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_3\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible\" ><label class='gfield_label' for='input_1_3' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_1_3' type='text' value='' class='large'   placeholder='Email' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_5\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_1_5' >CAPTCHA<\/label><div id='input_1_5' class='ginput_container ginput_recaptcha' data-sitekey='6LddC2ceAAAAAC-E3K8wo75OYpMkvdO8ULT4mIhS'  data-theme='light' data-tabindex='-1' data-size='invisible' data-badge='bottomright'><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' value='GIVE ME MY VOUCHER &gt;&gt;'  onclick='if(window[\"gf_submitting_1\"]){return false;}  window[\"gf_submitting_1\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} window[\"gf_submitting_1\"]=true;  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJbXSIsImI5ZjU1NDk1NzZmYjE5Y2ZjNDdkNDFlNmUzZjkwYTVjIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>            <\/div>\n            \t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-eae8348 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"eae8348\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-693ecdb\" data-id=\"693ecdb\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bcdbd72 elementor-widget elementor-widget-image\" data-id=\"bcdbd72\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"507\" height=\"161\" src=\"https:\/\/odellfamilychiro.com\/wp-content\/uploads\/2019\/06\/logo.jpg\" class=\"attachment-large size-large wp-image-461\" alt=\"O\u2019Dell Family Chiropractic\" srcset=\"https:\/\/odellfamilychiro.com\/wp-content\/uploads\/2019\/06\/logo.jpg 507w, https:\/\/odellfamilychiro.com\/wp-content\/uploads\/2019\/06\/logo-300x95.jpg 300w\" sizes=\"(max-width: 34.9rem) calc(100vw - 2rem), (max-width: 53rem) calc(8 * (100vw \/ 12)), (min-width: 53rem) calc(6 * (100vw \/ 12)), 100vw\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a8f4c99 elementor-widget elementor-widget-text-editor\" data-id=\"a8f4c99\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>Primary Location<\/strong><br \/>853 Ridge Rd<br \/>Webster, NY 14580<br \/>(585) 671-9210<\/p><p><strong>Secondary Location<\/strong><br \/>144 Metro Park<br \/>Rochester, NY 14623 US<br \/>(585) 671-9210<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Online FormsO&#8217;Dell Family Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Finish Your Forms Without Having To Come In ONLINE FORMS If you do not already have AdobeReader\u00ae installed on your computer,\u00a0Click Here\u00a0to download. Download the necessary form(s), print it out and &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/odellfamilychiro.com\/new-patient-center\/online-forms\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Online Forms&#8221;<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"parent":146,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Online Forms | O&#039;Dell Family Chiropractic<\/title>\n<meta name=\"description\" content=\"O&#039;Dell Family Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office. 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