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Call Us Today!
(502) 637-1005
Call Us Today!
(502) 637-1005

Patient Info

To speed up your office visits open the appropriate form below, fill it out, print it, and bring it to your visit with us.
Welcome Form – In order to serve you properly, we will need the following information. All information is confidential.
New Adult Health Information Form
New Pediatric Health Information Form
HIPPA Privacy Notice – all patients must review and sign this form prior to their first visit
HIPPA Compliance Form

Remember to bring these items with you to EVERY visit:

  • Insurance Card
  • Driver’s License
  • New or Established Patient Registration Form
  • All current medications including prescriptions, herbal supplements, vitamins or, alternatively, a COMPLETE medicine list including drug name, dosage level, and frequency taken