Patient Forms

 Click on each form name to download and print at your convenience. Please bring completed forms to your first appointment to expedite the registration process:

Print this form for your first visit if you have been accepted to our practice as a patient or if you have been referred to us from your primary healthcare provider.

We request that you also bring all your medications in the original bottles with you to each appointment.

 

Please arrive 15 minutes prior to your scheduled appointment.

 

You will need to present your insurance card at all visits.

 

For your first visit with us, we will need to see your driver’s license or another type of photo identification.

 

*These forms are in PDF format. If you do not have Adobe Reader installed on your computer you can download the program to view and print the forms by clicking here. 

© 2020 Copyright Mt. Sterling Clinic, PLLC

100 Sterling Way, Suite 1; Mt. Sterling, KY, 40353

Tel: 859-498-0200  |  Fax: 859-498-4771