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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
8:30am - 11:00am
3:00pm - 6:00pm


Tuesday
3:00pm - 6:00pm


Wednesday
8:30am - 11:00am
3:00pm - 6:00pm


Thursday
3:00pm - 6:00pm


Friday
8:30am - 11:00am


Saturday
Closed

Millpond Wellness Center
3650 Boston Road Suite 188
Lexington, KY 40514
(859) 219-0617

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