Patient Forms
When requesting a copy of your medical records, please use the medical release form below. All forms are in PDF format for downloading and printing.
- Medical Records Release Form Lexington Clinic is committed to providing information in a timely manner. For your convenience, please download the medical records release form, fill it out and mail it to Lexington Clinic, Attn: ROI, 2450 Palumbo Drive, Lexington, KY 40509 or you may fax to (859) 395-0909. If you have any questions, please call (859) 963-4076.
- Patient Account Information Authorization Release Form
- HIPAA Notice of Privacy Practices English Version 2014 January update
- Notification De Practicas De Privacidad Vigente: El 3 De Enero De 2014 (HIPAA Notice of Privacy Practices Spanish Version)
Information Forms for Dr. David Blake, Lexington Neurology
Information Forms for Gastroenterology
Information Forms for Radiology
- Radiology Colon Cleansing Patient Instructions
- IV Contrast Pre-Medication Patient Instructions
- Colon Cleansing Prep for BE, IVP and Colonography
- CT Exam Instructions 5-31-22
- Diagnostic/Fluoro/IVP Exam Instructions 6-2-22
- Lung Cancer Screening Information
- Intravenous Contrast Pre-medication Protocol
- Mammography Exam Instructions 5-31-22
- MRI Exam Instructions 6-2-22
- Nuclear Medicine Exam Instructions 6-2-22
- PET Exam Instructions 12-22-22
- Ultrasound Exam Instructions 6-2-22
Information Forms for Commonwealth Urology
- Commonwealth Urology Patient History Form New Patients: Print and bring completed form to your first visit
- Patient Agenda Form
Information Forms for Lexington Clinic Sleep Center
Lexington Clinic is Central Kentucky’s largest and oldest medical group. With 180+ providers in more than 30 specialties, we have been taking care of 600,000+ visits annually in the Lexington community since 1920.