Forms

General Forms

  • Privacy Notice
  • Patient’s Bill of Rights
  • Consent to be Treated
  • Medical Record Release
  • OB/GYN Payment Plan Agreement
  • Demographic Information Form
  • Patient Satisfaction Survey
  • About Our Sliding Fee Scale
  • Sliding Fee Application (Family Health & OB/GYN)
  • Sliding Fee Application (Dental)

KY School Physical Forms

  • KY Dental
  • KY Vision
  • KY Preventative Health Care Examination Forms K-4th grade
  • KY Preventative Health Care Examination Forms 6th-12th grade
  • Immunization Certificate

Sports Physical Forms

  • Kentucky Sports Physical Form
  • Ohio Sports Physical Form

Living Will Information

  • Kentucky Living Will Packet
  • Ohio Living Will Packet