Patient Intake Form
Welcome to our online Patient Intake Form. The information you fill in will be sent directly to our office, speeding up your office visit and allowing us to better serve your healthcare needs. Any questions that you answered "yes" to, we will be calling you for more detailed information, i.e. questions about medications, surgeries and health conditions. If it is more convenient for you to email us this additional information, our email addres is Optimumhealthchiropractic@outlook.com.