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Forms

  • A girl looks at an insect using a magnifying glass
  • A young boy sits against a tree trunk and looks over a pond
PreviousNext

Forms

Forms

For your convenience, our patient forms can be securely completed online.

Patient Forms & Downloads

New Patient Forms (Under 18 Years)

  • Patient Registration Form
  • Consent to Treat
  • Medical Records Transfer In / Transfer Out

Adult Patient 18 Years and Older

  • These forms are to be completed by the adult patient, not by the parent.
  • Patient Registration
  • Adult Patient Policy
  • Adult Patient Authorization to Use and Disclose Health Information
  • Letter to Parent of Adult Patient

Policy Documents

  • Office Policies
  • Financial Policy
  • Patient Privacy
  • Patient Portal Request

Well Child Exam Handouts

  • Well Child Screening Handout
  • Bright Futures HandoutsFor Parents
  • Bright Futures HandoutsFor Patients

School Forms

  • KY School Physical Form
  • KHSAA Middle School Athletic Form
  • KHSAA High School Athletic Form

Limestone Pediatrics

2351 Huguenard Drive
Suite 200
Lexington, KY 40503

Map & Directions
Give Us Feedback

Phone
859-260-7700

Billing (PedsOne)
866-371-6118

Fax
859-260-7797

Email
info@ptpediatrics.com
Non-medical questions only

Office Hours

Monday - Friday
7:30 am - 4:30 pm

Saturday
7:30 am - 11:00 am
Sick visits only.

Sunday
Sick visits by appointment only.

We require an appointment for your child to be seen.

After-Hours Care

If your child’s illness or injury is life threatening, dial 911.

For urgent matters that cannot wait until business hours, we offer a telephone triage consultation service that puts you in touch with a pediatric trained triage nurse. Call our office and follow the prompts. Fees may apply.

Poison Control Hotline
(800) 222-1222

Suicide & Crisis Lifeline
Dial 988
www.988lifeline.org

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