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Georgetown Pediatrics New Patients

Please fill out the forms below and bring the completed forms to the office 15 minutes prior to your appointment time..

Patient Registration Form (Adobe PDF) - Use this form to provide us information about your child.


Initial History Questionnaire (Adobe PDF) - Use this form to provide us information about your child.


Financial Policy (Adobe PDF) - Use this form to Authorize Medical Benefit payments to be made directly to Georgetown Pediatrics.


Privacy Policy Practices (Adobe PDF) - This notice describes how medical information about you may be used and disclosed and how you can access this information - please review it carefully.


Medical Records Release (IN) (Adobe PDF) - Use this form to allow us to receive your medical records from another facility.


Patient Portal Authorization Form (Adobe PDF) - Complete this form to authorize using our online patient portal.

Georgetown Pediatrics, P.S.C. - Pediatrician in Lexington, Georgetown, Scott County, Kentucky, Nicholasville, 40324, 40511, 40508, 40340, 40356, 40502, 40503, 40504, 40506. Fayette County, Winchester, Scott County, Jessamine County, Kentucky childrens doctor. Child doctor. Immunizations. Separate Well Visit and Sick Visit waiting rooms available. KHSAA Kentucky Sports Physical, Georgetown, Fayette, Jessamine County Kentucky. Kids Doctors serving Georgetown Kentucky and Surrounding Areas.Georgetown Pediatrics Office features 2 separate entrances for Well and Sick Children.