New Patient Paperwork
Millpond Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- PDF files must be saved to your desktop before and after completing!
- These forms cannot be filled out using a tablet or mobile device as they are not compatible.
- If you do not already have AdobeReader® installed on your computer,
Click Here to download. - Download the necessary form(s), print them out and fill in the required information.
- Bring the necessary form(s) to your appointment.
Health history Questionnaire
Complete this questionnaire and email to lexington@thewellnessway.com.
NOTE: This file must be saved to your desktop before and after completing.
Pediatric History
Attention Parents/Guardians: If you have a child age 4 or under, you will need to print out and complete the Pediatric History Form and not the Health History Questionnaire listed above. Bring this form with you to the office for your first appointment!
Signature Pages
Print out and complete the Signature Pages. Bring these forms with you to the office for your first appointment!
Functional Assessment Questionnaire
Complete the Functional Assessment Questionnaire online. This health review takes approximately 30 to 40 minutes to complete.
OFFICE HOURS
Monday
Available by Appointment
via Telehealth
Tuesday
Available by Appointment
via Telehealth
Wednesday
Available by Appointment
via Telehealth
Thursday
Available by Appointment
via Telehealth
Friday
Available by Appointment
via Telehealth
Saturday
Closed
Millpond Wellness Center
3650 Boston Road Suite 188
Lexington, KY 40514
Phone: (859) 219-0617
Fax: (859) 724-5280