Patient Forms, Map and Directions to Lexington Office
We are excited that you have chosen Poole and Thomas Pediatrics for your child's medical home. Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.
Our Mission
Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with educated and compassioniate care. To fulfull this mission, we are committed to:
To fulfill this mission, we are committed to:
- Improving the lives of the children we serve by providing quality care in a child-centered environment.
- Listening to our young patients and their families who we are privileged to serve.
- Guiding our patients along a path of optimal health and wellness.
- Continually pursuing excellence at all levels through continuing education.
Patient Forms
To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.
- 18 Year/Adult Patient Policy
- Letter to Parent of 18yr Old Patient
- 18 Year and Older Patient Registration [PDF] [SECURE ONLINE FORM]
- 18 Year and Older Authorization to Use and Disclose Health Information [PDF] [SECURE ONLINE FORM]
- Patient Registration [PDF] [SECURE ONLINE FORM]
- Patient Privacy
- Prenatal Registration
- Request for Release of Medical Records
- Financial Policy
- Consent To Treat, Medical Records, And Privacy [PDF]
- Medical Records Transfer In / Transfer Out [PDF] [SECURE ONLINE FORM]
- Medical History Questionnaire - Birth to 2years
- Medical History Questionnaire - 3years & older
- KY School Physical Form
- KHSAA Middle School Athletic Form
- KHSAA High School Athletic Form
- KHSAA COVID-19 Return to Play Guidelines
- Telemedicine Consent Form
In order to view or print these forms you will need Adobe Acrobat Reader
installed.
Click here to download it:
What to expect
A pleasant, comfortable first visit builds trust and helps put the child at ease during future visits. We want your child to enjoy getting to know our doctors and staff, so we work hard to establish this bond during every appointment to our office. During your initial appointment, we will explain everything in detail and answer any questions you may have.
We look forward to meeting you and your child and providing the quality, comprehensive medical care you expect and deserve.