Please Use Your Computer to Complete These Registration Forms

Due to the depth of your health information we capture the forms are not optimizable for completion on a phone or tablet and will interfere with electronic submission. 

Functional Medicine Evaluation with
Dr. Thomas Rohde

Please complete the following patient registration forms if you wish to be seen for a functional medicine evaluation, including thyroid, hormones, regenerative medicine including joint pain, PRP and Regenerative cell therapy, etc. 

This process should take you about 30 minutes.

Traditional Family Medicine, COVID, Cosmetic Procedures

Please complete the following patient registration forms if you wish to be seen for traditional/family medicine, a COVID consultation, or cosmetic procedures like Botox

This process should take you about 15 minutes. 

No-Scalpel Vasectomy

Please complete the following patient registration forms if you wish to be seen for our No-Scalpel Vasectomy Procedure. 

This process should take you about 15 minutes. 

Functional Medicine
Traditional Medicine
No Scalpel Vasectomy

If you prefer paper and pen, you can download our new patient packet using the link below. Completed forms should be returned to our office as soon as possible. 

Download New Patient Forms

For patients transferring care OUT to another doctor, please print the form below and return the completed document to our office.
Download Transfer of Care Form

 

LOCATION
  • Renew Total Body Wellness Center
  • 3798 E. Fulton Avenue
  • Decatur, IL 62521
  • Phone: 217-864-2700
  • Fax: 217-422-0004
OFFICE HOURS
  • Monday 8:00 - 12:00, 1:00 - 5:00
  • Tuesday 8:00 - 12:00, 1:00 - 5:00
  • Wednesday 8:00 - 12:00, 1:00 - 5:00 
  • Thursday 8:00 - 12:00, 1:00 - 5:00
  • Friday Closed
  • Saturday Closed
  • Sunday Closed
GET IN TOUCH
217-864-2700