Forms
For your convenience, The Pain Treatment Center of the Bluegrass offers online forms you can complete before your appointment. Please fill out all sections so we can provide timely and accurate care. If you have questions, our team is happy to help.
You may complete forms digitally by typing directly into the PDF, saving it to your computer, and submitting it by email, mail, or fax. You may also print the form, complete it by hand using black or blue ink, and mail or fax it to the appropriate department.
Submission Emails
- Medical Records Release: medrecs@pain-ptc.com
- Patient Portal Enrollment: accounting@pain-ptc.com
- Patient History Form: preu@pain-ptc.com
- Referral Form: preu@pain-ptc.com
Fax: 859-276-3847