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.

Medical Release Forms :

Release From Bluegrass Dermatology

Print Patient Contact and Medical Information Form


Release To Bluegrass Dermatology

Print Patient Office Consent Form