WANT TO BE ONE STEP AHEAD?

Print and complete the appropriate forms you need prior to your visit, and skip the hassle of appointment-day paperwork! 

Whether you're a new patient registering for the first time, or you've been with us from the beginning, having the right forms completed before your visit will make your appointment day a breeze!

NEW PATIENT REGISTRATION

If you're joining us as a new patient, welcome to the POBC family! We're glad you're here.  

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To make your first appointment run smoothly, please download the New Patient Registration Form, and bring your completed registration with you!  We look forward to learning more about your family and partnering in your journey of health and wellness!

MIDDLE SCHOOL

SPORTS PHYSICAL

Print this physical form for patients grade 6 - 8.  The parental questionnaire is lengthy and must be completed prior to being signed by the physician.  

FLU VACCINATION FORM

Coming in for your yearly flu shot? Click the form icon above and complete the short questionnaire.  You'll be in and out in no time!

CRAFFT ADOLESCENT SCREENING

The AAP recommends every patient aged 11-18 be screened for risk-taking behaviors.  Allow your child to complete this screening privately and honestly, so we can provide effective and appropriate counseling if needed.  

BCPS ALLERGIC REACTION FORM

This form is required for all BCPS students with a history of significant allergic reactions. Print this protocol sheet for the new year.

MCHAT

18 - 30 Month Well Checks

If your little-one is 18 - 30 months old and coming in for a checkup, get ahead of the game by completing MCHAT autism screening form above!  Your toddler will thank you!

HIGH SCHOOL

SPORTS PHYSICAL

Print this physical form for patients grade 9 - 12.  The parental questionnaire must be completed prior to being signed by the physician.  Print it early; there's a lot of questions!

BCPS ASTHMA FORM

This form is required for all BCPS students with asthma.  Print this asthma protocol sheet for the new year.

BCPS MEDICATION FORM

This form is required for all BCPS students who require daily or as needed medications administered at school.

SHEPHERDSVILLE

1707 Cedar Grove Rd, Shepherdsville, KY 40165

(502) 215-5090

Fax (502) 215-5095

MOUNT WASHINGTON

327 Eastbrooke Pointe Dr, Mt Washington, KY 40047

(502) 538-5090

Fax (502) 538-4089

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