gallery/ndc of lou
2505 Bush Ridge Drive, Suite A  Louisville, KY 40245    (502) 708-1338

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When you make your appointment you will need to download your forms or request to have them emailed to you.  It is best to look over the forms and website first if you have any questions, if you are not finding what you're looking for you may call the office or email us.  Please do not put any social security numbers on the forms, if they're needed we'll let you know when you come to your appointment.  Some tips for downloading and filling out your paperwork:

 

  • You will need a pdf reader to download and fill out the forms.  If you do not have one or are unsure if you do, you can download Acrobat Reader for free here. Make sure you uncheck "Optional Offers" if you only want the reader. 
  • It is important that you download the forms before you begin filling them out.  This ensures that the information you enter will be saved on your computer.  Without doing so you may not be able to save what you've filled out and will likely have to start over.  We suggest that even if you're printing your forms to fax or bring in, save them first to avoid having to fill them out again in the event of document/browser error.
  • If you email your paperwork back to us you must fill out the Electronic Medical Records Transmission form (pg 2) for us to be allowed to process your forms.  We cannot accept them via email without that form being signed.
  • It is not necessary to have a digital signature to electronically sign your forms, you may type in your name and then sign them when you get in the office. However, if you would like to add a digital signature you can find instructions on how to create one here (scroll down to Sign a PDF).
  • You may fax your paperwork to 502-708-1339, but please call or email the office to let us know you sent them.  If you leave a message please provide a contact number or email we can reach you at in the event we didn't receive them.
  • DO NOT send your completed forms to the office in the mail.  We often don't get them and we want to minimize the chance that your personal information may end up in the hands of those it was not intended for. If you cannot email or fax your forms you may bring them with you to your appointment.  In the event you forget or misplace them, call the office as soon as possible so we can get another copy to you. If it is the day of your appointment please come 15-20 minutes early to give yourself plenty of time to fill them out.  Please call the office first so they can have the paperwork ready for you to expedite the process.
  • Please double-check all of your information for accuracy and detail before emailing or faxing your forms.  
  • If any information changes after you have already sent in your paperwork you may make a correction and send it to us, but please make sure to get confirmation that we've made the change to your chart.
  • If you choose to print the forms please make sure that you have completed pages 2-6.  The other pages are optional and do not need to be brought with you to your appointment.
  • While we prefer that you download and email or print your paperwork, if you have no way of doing so you may request a copy to be sent to your home at any time.
  • You cannot upload your paperwork to the website.  You must either email it from a personal email address, fax it, or bring it into the office.

Registration Forms

Email Completed Forms Here