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Optimal Health & Wellness Center, Ltd. offers our patient form(s) online so you can complete it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.

• Download the necessary form(s), print it out and fill in the required information.

• Fax us your printed and completed form(s) or bring it with you to your appointment.

Chiropractic Patients:

New Patient Forms (Adults)
Download and Print Forms

New Patient Forms (Children)
Download and Print Forms

Child Nutrition Form
Download and Print Form 

Ideal Protein Patients

Ideal Protein Health Profile Form
Download & Print Form

Purification/Detox Forms:

New Patient Forms (Adults)
Download and Print Forms

Toxicity & Purification Forms (Goalsetting)
Download & Print Form

Toxicity & Purification Forms (Mid-point Cleanse)
Download & Print Form

Toxicity & Purification Forms (Toxicity Questionnaire)
Download & Print Form

Nutritional Consult Forms:

Adult Intake Form
Download and Print Forms

Food Diary Form
Download and Print Forms

Metabolic Assessment Form
Download and Print Forms

Nutritional Consultation Form
Download and Print Forms

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form


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Exclusive Offer

Special offer for new and current patients:
Enter your name and email for FREE INSTANT ACCESS to a report that will CHANGE YOUR LIFE TODAY!
Sign up using this form or call us at 630-858-9900 to take advantage of this exclusive offer.

THIS ---->https://optimalhealthctr.chiromatrixbase.com/new-patient-center/online-forms.html

Office Hours

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00–12:30 Closed 9:00–12:30 9:00–12:30 Closed Closed Closed
2:30–6:00 2:30–6:00 2:30–6:00


Thank you so much for helping my son we really learned a lot about health and how sophisticated the human body really is.


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