Patient Forms

Optimal Health & Wellness offers our patient form(s) online so you can complete it in the convenience of your own home or office. Here is a brief explanation of what each form is used for.

Patient Information – This form is required.

This form lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Please list any conditions or allergies you have that we need to be aware of.

Chiropractic Intake – Please fill it in along with the Patient Information form. This helps us understand the level of your discomfort, what you have previously done to try to relieve it, and your medical history. This helps us to heal you better.

Vitamin Injection Intake – This form is required for patients coming in for vitamin injections. Please list any medical conditions you are suffering from and health concerns you may have.

Nutrition Assessment – This form helps us understand your medical concerns as well as any nutritional health conditions you are suffering from.

Patient Information

Vitamin Injection Intake

Nutrition Assessment

Chiropractic Intake