Patient Registration

After you schedule your first appointment, please take a few minutes to fill out our electronic intake form. It will be submitted directly to us so you don't have to worry about printing it out. 

First Visit

On your first visit you should allow about an hour for paperwork, history, a detailed physical examination. Every patient receives a full physical examination to evaluate general health status and to completely examine any presenting problems. If additional diagnostic tests such as blood work or radiographs are necessary, additional time may be needed.


On your second visit, Dr. Olding will review your case with you and explain your diagnosis as well as his recommendations for treatment. 

Will insurance cover my visit?


Most plans do, however, insurance plan coverage varies. We are more than happy to verify your coverage and explain your benefits to you before your first visit. We will help you understand what your coverage means and find the best billing option for you.

Patient Registration Form

Please fill out the following form to help us understand your physical condition.

Have you been hospitalized in the last 12 months?
Are you currently suffering from a medical condition, illness, or injury?
May we contact you at work?
Are your symptoms getting worse?
Please describe your pain
Please describe your pain (continued)
What activities are difficult to perform

Health History

Please check ONLY conditions which are applicable
Please check ONLY conditions which are applicable
Please check ONLY conditions which are applicable
(Women) Select all that apply

Daily Habits

What type of exercise do you perform on a daily basis?
Do you smoke?
Do you drink alcohol?
Do you drink coffee?

Financial Policy

Unless other written arrangements have been made, payment is expected at the time of service. If third party payors are involved (health insurance, workers compensation insurance or personal injury) we will bill the payor AS A SERVICE TO YOU however you are ultimately responsible for payment for our services. *

At Southport Grace Wellness Center Ltd. we provide quality care with focus on the patient as a whole. Each patient receives the same level of focused attention. We have a limited number of appointment times available, which fill up quickly. In consideration of our time and with respect to other patients, please provide at least 24 hours notice when cancelling or rescheduling your appointment. Your appointment time is valuable and will likely be filled by another patient if we have adequate notice. If you miss your appointment, cancel your appointment, or reschedule with less than 24 hours notice, you will be billed based on the anticipated level of service, which will be no less than $40.00 and no more than $115.00. *

When scheduling appointments, we offer the option of an email or text confirmation and reminder. What would your preferred choice of contact be?

© 2020 by Southport Wellness

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