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

Fax : 859-296-4300
email : hr@mohs.com
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.


Patient Contact and Medical Information Form

Print Patient Contact and Medical Information Form


Patient Office Consent Form

Print Patient Office Consent Form


HIPAA Compliancy Form

Print HIPAA Compliancy Form

Medical Release Forms :

Release From Bluegrass Dermatology

Print Patient Contact and Medical Information Form


Release To Bluegrass Dermatology

Print Patient Office Consent Form