(502) 935-5633

info@loupeds.com

Resources

Please bring your completed forms with you to our office at the time of your visit.

New Patient Forms

Welcome Letter

Info & Questionnaire

Office Policy

Vaccine Policy

Appointment Policy

Notice of Privacy Practices

Medical Records Release Form

No Show Policy

Financial Policy

Consent to Treat Minor

School Forms

KY Schools Sport Physical 9-10

KY Schools Sport Physical 6-8

M-Chat Form

Initial Entry School Physical

Asthma Action Plan

School Medication Form

Other Forms

CDC Immunization Schedule

Medical Records Release Form

Patient-Payment-Plan-Agreement

Privacy Financial Notice

Statement of Non Discrimination

Privacy & Financial

Office Policy

Paving the Way for a Healthier Tomorrow