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  Phone: (270) 753-9300
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Downloadable Forms

Important!

You will need Acrobat Reader in order to print or type in any of our forms. The program is free and readily available on most computers. If, however, your computer doesn't have Acrobat Reader, you can click on the icon to the right to download and install it on your computer.

Patient Information Form

Minor Information Form

** You must fill this out if you are under 18 **

Patient's Medical History Form

This form is two pages long.

Patient's Rights and Responsibilities: Notice of Privacy Practices

Please read this notice and keep it in your records.

Acknowledgement of Receipt of Patient's Rights and Responsibilities

Print and sign to show that you have recieved the previous document on your Patient's Rights and responsibilities.

Filling Out the Forms

The forms can be filled out on a computer or they can be printed and filled out by hand. When using a computer, you can use a mouse to click in each field and type in your information. You can also use the [Tab] button to take you to the next form field quickly and easily.

Notice that you cannot fill in the signature area. Any document that requires a signature will have to be printed to be signed.

Printing

You can print by going to File >> Print in your Acrobat Reader.

If you fill the forms in using a computer, you will not be able to save them with your information on them. You must print them after you have filled them in.