Office Hours
8:30am-5:00pm Monday - Friday
Phone Operators are available 8:00am-5:00pm Monday - Friday
Phone:
859-263-5140 /888-422-3170
Fax:
859-263-5141
Prescription Refills Line:
859-422-4549
On average we receive 50-75 form requests per day for forms. The staff works diligently to ensure that all the forms are completed correctly. In order to properly process your request and treat everyone as fairly as possible, we need 7-10 days. At the time of your request, you will be assessed a charge for the completion of your form.
The forms below may be used for new and established patients to provide our office the most current information about you, your health status, your contact information, and your insurance coverage. To save time at your next appointment, please complete the forms attached below prior to your appointment and present them to the receptionist upon check-in.
Dr. Lockstadt's New Patient Form
Dr. D'Angelo's New Patient Form
Dr. Vasicek's New Patient Form
Dr. Balthrop's New Patient Form
Dr. Ellingsen's New Patient Form
Drs. O'Neill/Favetto's New Patient Form
Dr. Harrod's New Patient Form
Dr. Franzen's New Patient Form
Dr. Huff's New Patient Form