The following forms are for your benefit. Please download the form or copy and print and bring this form with you at your next scheduled visit.
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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. |
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Medical Records Release (IN) (Adobe PDF) - Use this form to allow us to receive your medical records from another facility. |
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Medical Records Release (OUT) (Adobe PDF) - Use this form if you want to release your records to another facility. |
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KHSAA High School Sports Physical Form (Adobe PDF) - Kentucky High School Athletic Association Sports Physical Form. Use this form if you will need a high school student athlete physical. |
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KHSAA Middle School Sports Physical Form (Adobe PDF) - Kentucky Middle School Athletic Association Sports Physical Form. Use this form if you will need a middle school student athlete physical. |
Georgetown Pediatrics Office features 2 separate entrances for Well and Sick Children.