To schedule an appointment with the Kentucky Physicians Health Foundation, please call
Instructions Once An Appointment Has Been Made*
Please print and complete this form, providing ALL information requested. Upon completion, please email it to
Missy Edwards at
or fax it to (502) 425-6871.
Step 2: Make Your Payment
Initial Consultation and Intake Interview $300
* Please note, we must receive your Initial Statistical Information Form and payment at least 48 hours prior to your appointment in order to avoid an automatic cancellation of your appointment time.