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
- 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
