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55 Caren Avenue, Suite 360 Worthington, OH 43085

Online Forms

Innovative Medical Centers offers our patient form(s) online so they can be completed 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

New Functional Medicine Patient Form:

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
New Client History and Lifestyle Intake Form

Food Sensitivity Test Questionnaire:

Food Sensitivity Testing Intake Form

Inflammation Questionnaire:

Inflammation Questionnaire

New Regenerative Medicine Patients:

New Regenerative Medicine Patient Intake Form

*THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAM, OR TREATMENT WHICH IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE OR REDUCED FEE SERVICE, EXAMINATION OR TREATMENT.