Below you will find our registration forms that can be filled out in advance.

Patient Registration

Consent to Treat

Health Questionnaire - You can download a copy of the form and fax it to 614-846-6662. You will need Adobe Reader to open the file.

Cancellation Policy

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Worthington Consultation & Behavioral Medicine

134 Northwood's Blvd, Suite B-1
Columbus, OH 43235

Phone: (614) 846-6611
Fax: (614) 846-6662


Office Hours
Wed: 6:30 pm-8:30 pm
Fri: 12:30 pm-4:30 pm