New Patients

If you have already scheduled a new patient appointment with our office, click the to left for the Online Intake Form. Thank you!

    Enter in the information as completely as possible. When you select an answer, more options may appear for you to choose in certain areas. Please allow 20-30 minutes to complete your intake information questionnaire.

  1. Only Pick One Area of Complaint at a time (even if allows you to choose more than one). Choose YES to "Does the pain travel/radiate?" if the pain includes more than one area e.g. the pain starts in the neck and goes into the shoulder.
    If you have two SEPARATE areas of complaint e.g. your neck and your low back have pain, complete the questions on the main area of complaint, and at it will ask if you have another complaint. You may add 4 complaints total.
  2. If an area of questions doesn't apply to you, please select the "No" option for that section, but please answer questions as completely as possible to ensure optimal care in our office.
  3. Please be advised, this intake form will replace some, but not all of the paperwork that needs to be completed in our office before you see the doctor.
  4. Please bring any insurance information, photo id, a list of medication with dosages, and be prepared to have your photo, height, weight, and blood pressure taken by our staff.
  5. If you have any trouble completing this online intake, please call our office as soon as possible to be sure we can collect your information BEFORE your appointment.

Please allow 20-30 minutes to complete your intake information questionnaire. If an area of questions doesn't apply to you, you can skip that section. Please be advised, this intake form will replace some, but not all of the paperwork that needs to be completed in our office before you see the doctor. You will also need to bring any insurance information, a list of medication with dosages, and be prepared to have your height, weight, and blood pressure taken by our staff.

Your information will be submitted directly to our secure servers, DO NOT PRINT your intake form.

We look forward to seeing you!

Thank you!

Optimal Health & Chiropractic Staff

Online Intake Form