Intake Packet

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New Client Web Forms

At Optimum Health & Wellness, we want our Clients to receive the best Service possible. To help expedite your in-office experience, we now provide our Intake Packet online so that you can fill it out before coming in for your appointment.

1. Click the Start  Intake Packet button below and please read through and fill out the appropriate fields on each form.

2. As you progress, you will be prompted to enter your initials, full legal name and a valid working email address.

3. At the bottom of each form you’ll see a large button to “Agree & Sign.”

4. There are (5) forms to complete. After you click “Agree & Sign” you will automatically be redirected to the next form.

5. You will be emailed a PDF copy of each completed form for your records.

*We work diligently to remain HIPPA compliant. All of our information is stored and sent encrypted. However, if you decide to share your personal information created with these forms, this is outside of our control and you do so taking full responsibility