Please download, print, read carefully, and sign the Consent Form and complete the Medical History Form
PLEASE COMPLETE AND RETURN THE CONSENT FORM AND THE PATIENT HEALTH FORM BEFORE YOUR APPOINTMENT AND PLEASE BRING IT WITH YOU TO YOUR APPOINTMENT. OR EVEN BETTER YOU MAY SCAN AND E-MAIL IT TO SEJMDOFFICE@INSIGHTBB.COM OR FAX IT TO (502) 899-9756 OR MAIL IT TO:
Susan E. Janocik, MD PLLC
4003 Kresge Way, Ste. 226
Louisville, KY 40207
+ Consent and Medical History Forms
