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Patient Forms


Every new M. T. Wellness Clinic patient completes four important forms prior to arriving for their Prime Appointment.  These forms capture vital information regarding each patient's health history, their problem issues, and their self assessment of their current pain levels and current physical function limitations.  The required forms are:

These four forms capture information that will be part of the foundation of both the Prime Appointment assessment and the customized plan of care developed by the therapist.  The information provided via these forms will help the therapist accurately and fully assess the patient's condition and to then develop an effective, customized plan of care.

 

All patient-provided information is treated as confidential, and will never be disclosed to any non-M.T. Wellness personnel without the express consent of the patient.

 
Typically, these forms will be discussed when scheduling your Prime Appointment.  You may print out and bring completed forms with you to your Prime Appointment.  Otherwise, we recommend that you arrive 15 minutes early to your Prime Appointment to complete these forms. New patient forms can also be mailed prior to the Prime Appointment. To obtain our new patient forms, please click the above links or contact us at 614-273-0810 or info@mtwellnessclinic.com.
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TRAINING CENTER
1151 Bethel Road
Suite 303
Columbus, OH 43220
P: (614) 273-1445
F: (614) 273-0173
E: info@mtwellnessclinic.com