BG Internal Medicine & Pediatric Associates
  • Home
  • PROVIDERS
    • Sarah A. Mayfield, MD
    • Paul A. Kniery, MD
    • Kelly E. Kries, MD
    • Casey L. Miles, MD
    • Ashley R. Parrigin, APRN
    • Kyla M. Byard, APRN
    • Jenna E. Tarter, APRN
    • Ariel J. Mujakovic, APRN
  • Portal
    • Patient Portal
    • Patient Portal Request
  • Current Patients
    • ACO 2021 Annual Notice
    • billing >
      • Financial Assistance
      • Insurances & Billing Department
      • Pay your Bill
    • Covid 19 >
      • COVID 19 Vaccine Information
    • HIPAA
    • Important Office Updates
    • Medical Grade Ear Piercing
    • Office Policies >
      • Immunization Policy
      • No Show Policy
      • Sports/Camp Physicals
    • Patient Forms
    • Televisits
  • NEW PATIENTS
    • New Patient Information
    • New Patient Request
  • Clinical Research Opportunities
  • Contact Us
  • Office Information
  • Online Appointments
  • Resources
    • Answers to After Hours Questions
    • Car Seat Regulations
    • Dosage Charts >
      • Tylenol and Ibuprofren Dosing Instruction
    • Newborn Booklet
    • Parent Handouts
    • Related Links
    • Symptom Checkers
    • 24 Hour Nurse Hotlines
  • Inclement Weather Plan
  • AESTHETICS
    • Bowling Green Aesthetics

Patient Forms

To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat you and/or your child. You may also download and print the forms from our website, fill them out ahead of time, and bring them in with you to your appointment or email back to us prior to your appointment at records@bgimp.com
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  • 18 Year/Adult Patient Policy
  • Letter to Parent of 18yr Old Patient
  • 18 Year and Older Patient Registration
  • 18 Year and Older Authorization to Use and Disclose Health Information
  • Consent to Treat
  • Financial Policy
  • Medical Records Transfer In/Transfer Out
  • KY School Physical Form
  • KHSAA Middle School Athletic Form
  • KHSAA High School Athletic Form
  • New Patient Pediatric Registration Forms
  • New Patient Adult Registration Forms
  • Annual Demographics Update ​
  • Kentucky Living Will Advance Directive

Well Child Forms

  • 3 to 5 Day Visit
  • 1 Month Well Baby Visit
  • 2 Month Well Baby Visit
  • 4 Month Well Baby Visit
  • 6 Month Well Baby Visit
  • 9 Month Well Baby Visit
  • 12 Month Well Baby Visit
  • 15 Month Well Baby Visit
  • 18 Month Well Baby Visit
  • 2 Year Well Child Visit
  • 3 Year Well Child Visit
  • 4 Year Well Child Visit
  • 5 Year Well Child Visit
  • 6 Year Well Child Visit
  • 7 Year Well Child Visit
  • 8 Year Well Child Visit
  • 9 Year Well Child Visit
  • 10 Year Well Child Visit
  • 11-14 Year Well Child Visit-Patient Questionnaire
  • 11-14 Year Well Child Visit-Parent Questionnaire
  • 15-17 Year Well Child Visit-Patient Questionnaire
  • 15-17 Year Well Child Visit-Parent Questionnaire
  • 18-21 Year Well Visit
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OFFICE HOURS

Monday-Friday   8 am to 5 pm
Saturday 8 am to noon
Sunday  closed
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CALL US!
270-846-4800
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Fax: 270-846-4828

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FOLLOW US ON SOCIAL

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PAY ONLINE

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PATIENT PORTAL


Patient Forms
​
Parent Handouts
Medication Dosage Charts
​
Office Policies
Newborn Book​

BGIMP
​615 7th Avenue
Bowling Green, KY 42101
  • Home
  • PROVIDERS
    • Sarah A. Mayfield, MD
    • Paul A. Kniery, MD
    • Kelly E. Kries, MD
    • Casey L. Miles, MD
    • Ashley R. Parrigin, APRN
    • Kyla M. Byard, APRN
    • Jenna E. Tarter, APRN
    • Ariel J. Mujakovic, APRN
  • Portal
    • Patient Portal
    • Patient Portal Request
  • Current Patients
    • ACO 2021 Annual Notice
    • billing >
      • Financial Assistance
      • Insurances & Billing Department
      • Pay your Bill
    • Covid 19 >
      • COVID 19 Vaccine Information
    • HIPAA
    • Important Office Updates
    • Medical Grade Ear Piercing
    • Office Policies >
      • Immunization Policy
      • No Show Policy
      • Sports/Camp Physicals
    • Patient Forms
    • Televisits
  • NEW PATIENTS
    • New Patient Information
    • New Patient Request
  • Clinical Research Opportunities
  • Contact Us
  • Office Information
  • Online Appointments
  • Resources
    • Answers to After Hours Questions
    • Car Seat Regulations
    • Dosage Charts >
      • Tylenol and Ibuprofren Dosing Instruction
    • Newborn Booklet
    • Parent Handouts
    • Related Links
    • Symptom Checkers
    • 24 Hour Nurse Hotlines
  • Inclement Weather Plan
  • AESTHETICS
    • Bowling Green Aesthetics