Chiropractic, Massage, Nutrition and Weight Loss, Acupuncture, Stress Reduction Therapy, Integrative Health
(614) 848-5211 Google Map

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 Form (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
8:00am - Noon
2:30pm - 6:00pm
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


This is what WOW does — you crawl in and skip out. I injured myself so badly I couldn’t even get to WOW for a couple of weeks. Yesterday, after seeing Ray and Dr. Keiser it felt like a miracle. Amazing Grace! The intelligence, the compassion, the sincere commitment they give is a gift that nourishes your body and soul. I am so grateful and feel so much better today. Thank you so much!

Carole Dale