Schedule a New Patient Appointment | THE ARMORY | Columbus, Ohio
  • THE ARMORY

  • Schedule a New Patient Appointment

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  • Please select a provider from the list below*
  • What type of appointment do you prefer?*

  • Demographic Information

    Please provide your basic personal information. Accurate details help us maintain your medical record and ensure all communication and documentation are correct.
  • Format: (000) 000-0000.

  • By providing your phone number and submitting this form, you consent to receive SMS text messages from THE ARMORY. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out or HELP for more information. Consent is not a condition of purchase. See our Privacy Policy for details. 

  • Preferred Method of Contact*
  •  - -
  • Gender*

  • Insurance Information

    Although THE ARMORY does not bill insurance for any services, we require your insurance information for our records. This information may be used when coordinating prescriptions, obtaining prior authorizations, or referring you to outside providers such as labs, imaging centers, or specialists.
  • Do you have health insurance?*
  • Please select your insurance provider. We do not bill insurance directly, but keep this on file to help coordinate your care.
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  • Pharmacy and Laboratory Information

    Please provide your preferred pharmacy and laboratory information. This allows our team to coordinate prescriptions, prior authorizations, and lab testing efficiently. If you haven’t had recent labs drawn, we’ll generate an order for you and contact you once results are available to schedule your provider visit.
  • Do have a preferred pharmacy?*
  • What is the name of your preferred pharmacy?
  • Do have a preferred lab for blood draws?*
  • What is the name of your preferred lab?

  • Current and Past Medical History

    Tell us about any current or past medical conditions, injuries, or surgeries. Sharing this helps us get a full picture of your health and provide the best care possible.
  • Are you healthy enough to exercise?*
  • Have you ever been diagnosed with any of the following medical conditions?*
  • Check all that apply
  • Are you currently injured?*
  • Have you had any relevant surgeries in the past?*
  • Are you currently taking any prescription or over-the-counter medications? *
  • Do you have any allergies we need to know about?*
  • Are you currently taking any athletic or performance supplements?*
  • Check all that apply
  • Are you currently taking or have you recently taken any illicit or performance-enhancing substances? Note: We’re here to help you, not judge you. Our team is extremely knowledgeable in this area, and our priority is to keep you safe and out of trouble.*
  • Check all that apply

  • Exercise Physiology

  • Is this your first time seeing Breyona?*
  • What are your main goals for meeting with an Exercise Physiologist.*
  • What best describes your current exercise patterns? (Check all that apply.)*
  • What barriers make it difficult for you to exercise consistently?*
  • Have you had V02max testing in the past 3-6 months*

  • Dietitian/Nutrition Consult

  • Is this your first time seeing Samantha?*
  • Which type of nutrition visit best fits the your needs today?*
  • What are your primary goals for meeting with the dietitian? (Select up to 3 choices)*
  • Are you following any specific dietary restrictions?*
  • Are you currently experiencing any of the following gastrointestinal (GI) symptoms?*
  • Have you ever been diagnosed with any of the following gastrointestinal (GI) conditions?*
  • Have you completed a Resting Metabolic Rate (RMR) Test within the past 60 days?*

  • Physical Therapy New Patient Referral Form

  • Hi! Thank you for choosing THE ARMORY for your physical therapy needs.

    Please note that we do not accept insurance as a means of payment for physical therapy services rendered. All services must be paid for with cash or card at the time of service.

    Pricing is as follows:

    • Medical member - $100 per visit
    • Non-medical members - $200 per visit
  • What is your membership status?*
  • Is this issue due to an injury?*
  • Have you previously had surgery on this area?*
  • Have you previously seen a Physical Therapist for this within the past 12 months?*

  • Patient Acknowledgment


    By signing the form below, I acknowledge and agree to the following:

    1. I understand that payment is due at the time of service, and that no care will be provided until payment is received.
    2. I understand that providers at THE ARMORY are not credentialed with Medicare, Medicaid, or any commercial insurance company. All services are considered out-of-network and cannot be submitted to insurance for reimbursement.
    3. I understand that a $75 cancellation fee will be applied if I fail to provide at least 24 hours’ notice to reschedule or if I do not show for my appointment.
    4. I understand that I may use HSA or FSA funds for this service, and that an itemized invoice can be provided by the office upon request.
  • Do you acknowledge and agree to the terms above?*
  • How did you hear about THE ARMORY?*
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