New Patient Forms from Our Functional and Nutritional Wellness Center

Please Download the following forms and fill out in there entirety. Forms need to be returned to the office a minimum of 3 days prior to your initial appointment via fax, email, or postal service.  For more information on working with a Functional and Nutritional Wellness Practitioner click Working with A Functional and Nutritional Wellness Practitioner.

Health Questionnaires

If your child is under 15 years old, or is older than 15 and considered autistic or on the autism spectrum, please fill out the Pediatric Health Questionnaire.

If you have any questions please call the office at (920) 743-4221.

Return Forms to:
Center for Optimal Health
242 Michigan Street, Suite #202
Sturgeon Bay, WI 54235

Or Fax to (920) 743-5344

Share This Page