Online Patient Forms

Please click on the links below in order to complete our forms prior to visiting the practice.

This should save about 15-20 minutes.

New Patient Forms

Confidential Patient Information (PDF)

New Patient Welcome Form (PDF)

New Patient Health Profile (PDF)

Pediatric Patient Introduction Form (PDF)

Personal Injury Insurance Forms

Assignment and Instruction for Direct Payment to Doctor (PDF)

Personal Injury Form (PDF)

Personal Injury Financial Policy (PDF)

Personal Injury Questionnaire (PDF)

Returning Patient Form

Returning Patient Form (PDF)

United Health Care Patient Forms

Patient Summary Form (PDF)

Back Index Form (PDF)

Neck Index Form (PDF)

Musculoskeletal Tool (PDF)

Acupuncture Intake Form

Acupuncture Intake Form (PDF)

These forms are in PDF format, if you have trouble viewing the forms, you can download a Free PDF reader here.

Contact Info and Hours

Worthington Optimal Wellness
6180 Linworth Road
Worthington, OH 43085
Google Map
(614) 848-5211
Our Hours
Monday – Thursday:
8:00am – Noon
2:30pm – 6:30pm
Friday:
8:00am - Noon
2:30pm - 6:00pm
Saturday:
9:00 am – 11:00 am

Schedule Appointment

To schedule an appointment, please call our front office staff at (614) 848-5211. We look forward to hearing from you.

Calendar of Events

Download The 5 Secrets of Optimal Health

Reviews

The doctors and staff at Worthington Optimal Wellness are always prompt, personal and are community minded. They offer many treatment modalities. They have improved my quality of life.
Cheryl Rakich