Family Medical Center

...the cornerstone of healthcare in Bardstown for over 50 years 

 

201 S. 5th St.
Bardstown, KY 40004

ph: 502-348-5968
fax: 502-349-0963

Patient Documents

The following documents are in PDF format.  You must have Adobe Reader in order to view them.

 Patient Registration (PDF, Word)

This form allows us to gather your demographic and insurance information.  Please print it out, and bring it to your first visit.  If it has been over a year since you've been in, please fill it out as well so we can make sure we have your latest information.

Rx Hub Consent

This consent authorizes us to contact your pharmacy and prescription plan electronically as detailed on the form.

Quick Info Sheet

This 1-page sheet offers information about the office and our policies in a brief format.  Please see the Frequently Asked Questions for a more detailed discussion.

School Physical (K-4)

This physical form is provided by the state of Kentucky for school entry for children entering kindergarten through 4th grade.  Please print and fill out your portion of this form before your office visit.

School Physical (Grade 5-12)

This physical form is provided by the state of Kentucky for your child's 6th grade physical and is valid for grades 5-12.  Please print and fill out your portion of this form before your office visit.

Sports Physical

This physical form is provided by the state of Kentucky for sports participation exams.  Please print and fill out your portion of this form before your office visit.

CDL Physical

This physical form is provided by the state of Kentucky for CDL examinations.  Please print and fill out your portion of this form before your office visit.  You will receive the registration card at the completion of the physical.

Handicap Parking Permit

This is the form by the state of Kentucky required in order for you or your family member to obtain a disalbed persons special parking permit.

Crossbow Permit

This is the form from the state of Kentucky required in order for you to use a crossbow for hunting.

Notice of Privacy Practices

Bardstown Primary Care is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information.  Please download this document to review these practices.

Call Us Today!

We have open appointments available each day.  Call our staff now at 502-348-5968, and let us help take care of you.


Copyright  2010 Family Medical Center.

Revised 7/9/10.

All rights reserved.

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201 S. 5th St.
Bardstown, KY 40004

ph: 502-348-5968
fax: 502-349-0963