Patient Registration Forms            

All new patients must complete three forms. Please choose and print out the right form from
section A, below, and also print out the forms in sections B and C, below.   
Fill in all answers clearly, in ink.
If your scheduled appointment is at least 2 weeks away, mail the completed forms to:
            
            Kentucky Sports Medicine - Patient Registration
            601 Perimeter Drive, Suite 200
            Lexington, Kentucky 40517

If your scheduled appointment is less than 2 weeks away, bring the completed forms to your appointment at Kentucky Sports Medicine.

If you cannot print and complete these forms before your appointment, please arrive at least 30 minutes early
for your appointment — you will have to complete the forms prior to seeing the physician.

A. KSM Registration Form:

 

1. General Patient Registration
Click here for this form (to be used by most patients)

2. Athlete/Child/Student Registration
Click here for this form, if patient is a student athlete or covered under parents' insurance.

3. Workman's Compensation Registration
Click here for this form, if patient is a Workman's Compensation patient.

B. Information and Privacy Consent Form:

  Click here for this form (all patients).

C. Medical History Form:

  Click here for this form (NEW patients).

Click here for this form (RETURNING patients).