Forms

New Patients

• New Patient Registration Form
• New Patient History
• Notice of HIPPA Privacy Practices
• Release of Information TO Highlands Family Doctors from Others
• Permission to use Email to Communicate with Patients

You may fill out these documents prior to your visit to save time. We need the complete set of documents on file for you to be seen.

Pediatrics

• Children's Power of Attorney giving formal permission for others to make on-going medical decisions for your children
• Minor Consent to Treat for use when parents are temporarily out of town

All Patients

• Kentucky Living Will Directive: This is a Living Will template for patients desiring to make an advanced directive
• Genogram: This is a template allowing the patient and doctor to organize your family medical history in a 'tree' form
• Highlands Family Medicine's Viral URI Prescription: strategies to treat your Cold & Flu symptoms while your body cures itself

You will need to have Adobe Reader on your computer to view or print these documents: