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Kentucky Orthopedic Clinic

Patient Forms
It is our goal at Kentucky Orthopedic Clinic to make your visit as comfortable and enjoyable as possible. One way to expedite the waiting process is to come a little extra prepared. The following forms may be printed, filled out and brought to your next appointment:

New Patient Information Sheet Authorization for Release of Information Motor Vehicle Accident Info Sheet
MRI Pre-Screening Form Request to Inspect and Copy Protected Health Info Workers Compensation Form
   

Feedback: Patient Survey




patient portal

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Patient Forms

Contact Us

CORBIN LOCATION
Kentucky Orthopedic Clinic: (606) 258-0300
MRI Research Institute: (606) 528-8400
Toll Free: 877-4KY-ORTHO / (877) 459-6784

MIDDLESBORO LOCATION
Kentucky Orthopedic Clinic: (606) 248-0050
Open MRI of Kentucky: (606) 248-0050
Toll Free: 888-MRI-TEAM / (888) 674-8326

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Radiology Info

PROSCAN Imaging

American College of Radiology