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Vertical File Cabinet

Office Forms

If you need assistance or have any questions about any of our forms please call the office. 

Doctor's Desk

New Patient Forms
- Newborn

Congratulations on the arrival of your new baby. Please completely fill out all forms and bring to your first appointment. We ask that you please arrive 10-15 minutes early to give staff time to load your information into our system.  

New Patient Forms - Infants/Children/Adolescents

Please completely fill out all forms and bring to your first appointment. We ask that you please arrive 10-15 minutes early to give staff time to load your information into our system.  

Medical Release
Form

If you would like to have your child's records sent to us or you would like us to release your records to another provider please completely fill out the form, sign, and date.

KHSAA Physical Form (grades 6-8)

These are pre-participation clearance forms required by the KHSAA agency to participate in school sports. Please fill out your portion before your appt.

KHSAA Physical Form
(grades 9-12)

These are pre-participation clearance forms required by the KHSAA agency to participate in school sports. Please fill out your portion before your appt.

Kindergarten Entrance
Form

Kentucky schools require each child first entering a Kentucky public school or entering Grade 6 to present a Kentucky Preventative Health Care Examination Form.   

@2022 Willow Tree Pediatrics of Lexington

2036 Regency Road, Suite 2

Lexington, KY  40503

859-286-9046

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