Download Forms
If you would like to save time prior to your appointment at WellOne, please download the following forms and complete them before your appointment. If you recently visited one of our locations and have already completed the forms, there is no need to fill this out.
Adult Health History Form – New Patients
adult_health_history_-_new_patients.pdf
Adult Health History Form Update – Current Patients
adult_health_history_update_-_current_patients.pdf
Child Health History Form – New Patients
child_health_history.pdf
Reduced Fee Application
Reduced_Fee_Application_2010.pdf
Medical Records Release Authorization Form
medical_record_release_form.pdf
Note: WellOne does not release any medical records information regarding any patient, unless authorized by both the patient and the healthcare provider.