NEW PATIENTS & FORMS

New Patients:

 

Set up an Appointment: (606) 219-4184 

 

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Forms:

FYI- You can get results faster if you download and fill in these forms before your appointment.  Please drop them by our office or FAX to: 606-678-8368 

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For All Patients:

Authorization for Release of Information​

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Insurance & Payment Policy Agreement​

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Optional Patient Forms:

If You are Pregnant, please fill in: Pregnancy Consent Form

 

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Forms for Referring Physicians:

ICD-10 Lookup Codes for ABI, CT Lung Cancer Screening and DEXA

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