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Registration Forms

Patient
Bill of Rights

Patient Registration 
Forms

Patient Confidential Communications

Consent to Treat, Agreement to Charges, HIPPA Notice, & Proxy

Dax
Consent

Telehealth Consent
 

FTCA
Notice
 

Sliding Fee Application
 

Waiver and Consent Form for Clark County School Clinic

Release of Information

Contact Us

Versailles Road Clinic

1306 Versailles Road
Suite 120
Lexington, KY 40504
Phone: (859) 259-2635
Fax: (859) 254-7874

Mon – Thurs: 8am to 8pm
Friday: 8am to 6pm
Saturday: 8am to 4pm

Eagle Creek Clinic

131 North Eagle Creek Drive
Lexington, KY 40509
Phone: (859) 263-2507
Fax: (859) 254-7874

Mon – Fri: 8am to 6pm
Saturday: Closed

New Life Day Center Clinic

224 North Martin Luther King Blvd.
Suite 200
Lexington, KY 40507
Phone: (859) 977-7474

Fax: (859) 254-7874

Mon-Fri: 8:30am-4:30pm

Clark County Clinic

100 Vaught Rd
Suite 1
Winchester, KY 40391
Phone: (859) 977-7482
Fax: (859) 254-7874

Mon – Fri: 8am to 4:30pm

Eagle Creek Pharmacy

131 North Eagle Creek Drive
Lexington, KY 40509
Phone: (859) 977-7481
Fax: (859) 369-2963

Mon – Fri: 9am to 5pm

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