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 Registration/Patient Insurance Form
- KHSAA Eligibility Rules and Parental Permission From Bylaw References
- Patient Account Information Authorization Release Form
Medicare Annual Wellness Visit Questionnaire
- Medicare Annual Wellness Visit Questionnaire - Please download and print this form. Complete the form and bring with you to your Medicare Annual Wellness Visit appointment with your provider.
Information Forms for Gastroenterology
- Instructions for Colonoscopy Only or Colonoscopy/EGD Procedures 7-11-18 Update
- Small Bowel Capsule Endoscopy Patient Instructions 6-23-2022
- What to Expect During a Small Bowel Capsule Endoscopy Test
- Colonoscopy Instructions CLENPIQ Patients 5-9-2022
- Colonoscopy Instructions GoLytely Patients 5-9-2022
- Colonoscopy Instructions PLENVUP Patients 5-9-2022
- Colonoscopy Instructions SUPREP Patients 5-9-2022
- Colonoscopy Instructions SuTab Patients 5-9-2022
- Colonoscopy Prep_Frequently Asked Questions
- Patient Information and Instructions for EGD (Esophagogastroduodenoscopy)
- Flexible Sigmoidoscopy information and instructions
- Percutaneous Endoscopic Gastrostomy (PEG) placement instructions
Information Forms for Dr. David Blake, Lexington Neurology
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/CT Exam Instructions 5-31-22
- PET/CT Diet Information 5-31-22
- 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 Demographic/Patient Insurance Form
- Patient Agenda Form
- Financial Policy
Information Forms for Lexington Clinic Orthopedics - Sports Medicine
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.