New Patient Intake Form

Instructions and Reminders

Before You Begin

Thank you for choosing Central Ohio Nutrition Center for your continued medical care!

Our intake forms are easiest to complete on a desktop or laptop computer. For the best experience, please use Google Chrome or another modern desktop browser.

Please complete all assigned forms at least 90 minutes before your appointment. If you are unable to do so, please plan to arrive 30 minutes early to allow time for completion.

The full intake typically takes about 20–30 minutes. Each page is saved individually when you submit it, so you may complete some sections now and return to the remaining sections later.

If you stop before finishing, you will receive an email reminder with a link to resume approximately 2 hours after your last form submission.

Please use the same email address on every page so we can correctly match all of your forms to your record.

If a required field does not apply to you, enter “N/A” or select the answer that most closely applies.

Initial Exam Appointment Reminders

For most patients, please allow 90 minutes to 2 hours for your Initial Exam appointment.
If having blood work done
- You must be fasting for 8 hours
- Drink plenty of water and other caffeine-free, non-caloric beverages (Stop 45 minutes before your appointment)
- Take medications you can tolerate on an empty stomach
- You may bring something to eat after your lab draw takes place so you can take the rest of your medications
For the body composition test/EKG:
- No lotion/ointment/powder on body, especially hands or feet.
- Do not exercise for at least 3 hours.
- No alcohol or excess caffeine for 24 hours.
- No fluids for 45 minutes before your appointment.

Have You Submitted Your Insurance Information?

If you have not already completed your insurance information, please do so before your appointment so our team can review your coverage and provide cost information when possible.

Insurance Information

Have Additional Medical Records to Share?

If you have recent lab results, imaging, test results, medication records, or other documents you believe may be helpful to your care, you can upload them securely using the link below. This step is optional.