P: 502.935.5633

F: 502.935.5706

M-F 8:30am – 5pm

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REGISTRATION

For your first visit, please bring the following:

Your current insurance card

Your co-payment as stated on your insurance card

Any pertinent information regarding your child's past medical history, especially immunization records

In order to make your first visit to Louisville Pediatric Specialists as quick as possible, we ask that you print out the following forms, fill them out and bring them with you on your first visit to our office.

HIPAA notice of privacy practices

Medical Records Release Form

Consent Of Treatment To A Minor

New Patient Questionnaire

Insurance Verification

Patient Financial Agreement

Medical Records Request Form

Patient Contact Form

Patient Financial Policy

LOCATION

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Louisville Pediatric Specialists, P.S.C.
6801 Dixie Hwy.
Dixie Manor Medical Mall
Suite 127
Louisville, KY 40258

CONTACT

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Phone: 502.935-5633
Fax: 502.935.5706

BILLING

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Please enter your Account Number in the “Customer ID” field on the payment form

GET SOCIAL

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