Please print and sign the appropriate Medical Release form and either fax, email, or mail back to:

Fax : 859-296-4300
email :
US Mail : 3475 Richmond Road Suite 200 Lexington, KY 40509

Please note that once we receive a signed copy of your medial release it will take 24-48 hours to process your request.

Online New Patient Application

The online registration forms can take up to 24 hours to process in our system, if your appointment is within 24 hours please print the registration information & arrive 30 mins prior to your appointment time with your completed information.

Apply Online! Check the status of your online application

New Patient Registration Packet

Print Patient Contact and Medical Information Form

Medical Release Forms :

Release To OR From Bluegrass Dermatology (both forms)

Print Patient Contact and Medical Information Form