Patient Forms

Need a well visit appointment, paperwork, or medication refill?

Go to our Patient Portal.

Office Forms

ADHD Forms

Financial Policy

Flu Consent

Foster Care

Notice of Privacy Practices

Records Release

Sports Physicals

ADHD Information Sheet
Guidelines for ADHD Scheduling
Required form for ADHD stimulant medications.
New patients must review and acknowledge this form.
Please sign this form and bring it into the office at your first visit
Find answers to your FAQs on Billing here
Flu Vaccine Consent Form
Please fill out this form for any new foster children you are caring for.
This form shows how we use and secure your protected health information (PHI). It must be reviewed and signed by new patients.
All patients 18 years and older need to fill this out so we have permission to release records and talk to their designated family members. This includes access to the portal.
Please fill this out to get records from outside physicians, clinics, hospitals and school psychologists.
Consent to Treat Form
Print and fill out pages 1-4 if your child plays middle school sports in Kentucky. If they have had a well visit in the last 12months, we can fill it out based on that visit. If it has been more than 12 months since their well visit, please call to schedule and we can fill it out at their visit.
Print and fill out pages 1-4 if your child plays high school sports in Kentucky. If they have had a well visit in the last 12months, we can fill it out based on that visit. If it has been more than 12 months since their well visit, please call to schedule and we can fill it out at their visit.
Print and fill out pages 1-2 if your child plays high school sports in Ohio. If they have had a well visit in the last 12months, we can fill it out based on that visit. If it has been more than 12 months since their well visit, please call to schedule and we can fill it out at their visit.
Print and fill out pages 1-2 for your high school student playing sports in Indiana. If they have had a well visit in the last 12months, we can fill it out based on that visit. If it has been more than 12 months since their well visit, please call to schedule and we can fill it out at their visit.