Consultation Form

The purpose of your initial consultation is to review your concerns and symptoms, discuss what treatment options are available to you, and costs associated with those options.

How the initial consultation works

  • You submit
 the form – Fill out and submit the form below with your contact info, medical history, etc. We recommended using a desktop/laptop rather than a mobile device.
  • We review your info
 – One of our providers will review your medical history, symptoms, and areas of concern.
  • We contact you – 
If you have not already scheduled your consultation, a member of our staff will contact you within a business day to schedule your consultation appointment. You can also call us at (513) 791-9474 to schedule your consultation once you have completed the form.
  • Full evaluation – 
During your appointment, the provider we will evaluate your current symptoms, medical history, family history, recent changes in symptoms and lab results when applicable. All treatment options and costs will also be reviewed. Our goal is to develop a tailor-made solution just for you.
  • No obligation
 – There is no commitment beyond the initial consultation. A copy of the suggested treatment plan will be provided for you and we hope that you feel entirely educated about your symptoms and available treatment options.

Your private information is safe! It is encrypted and transmitted securely through the form below using SSL (Secure Sockets Layer), the same security technology bank websites use. We understand that some people are not comfortable with submitting their personal health information online so we also provide a PDF version(make text a downloadable link for the PDF) of the form that you can download if you prefer. Just complete it offline and e-mail it to YWC at info@yourwellnesscenter.com You can also fax it to 513-791-9474.