FORMS
Here you will find some of our patient forms and policy agreements. Please PRINT and fill out prior to your appointment. Once you complete them, please email to frontdesk@midpeds.com or fax to 502-244-9575.
PATIENT REGISTRATION FORM
GENERAL CONSENT FORM
VACCINE POLICY
FINANCIAL POLICY
PATIENT HEALTH HISTORY FORM (New Patients Only)
KHSAA Sports Physical Forms (grades 9-12)
https://khsaa.org/forms/ge04-total-requiredge04andoptionalppe01.pdf
KHSAA Sports Physical Forms (grades 6-8)
https://khsaa.org/forms/ms01-total-requiredms01andoptionalppe01.pdf