Patient Resources
Patient Forms
To expedite your wait while in the office, please download the necessary forms below (Adobe Reader required). Please bring the most recent copy of your insurance card. If you have any questions, please feel free to contact us by email or by calling our office directly at (606) 256-4148.
Registration Form:
- Patient Registration Form
- Initial Patient History Form
- Consent for Care Using Telehealth Form
- Privacy Practices Information (HIPAA)
- PHQ-9 Modified for Teens
- RockPeds Immunization Policy
Other Forms:
- ADHD Medication Agreement and Consent
- NICHQ Vanderbilt Assessment Scale (For Teachers)
- NICHQ Vanderbilt Assessment Scale (For Parents)
- Authorization for Release of Medical Information
- High School Sports Physical KHSAA (2023-24)
- Middle Schools Sports Physical KHSAA (2023-24)
Office Policies and Information
For helpful information about how our office works, click here.
Annual Well Checks
Well checks provide a broad focus on wellness. Well checks are intended to help the child and the parents with focus on health promotion, guidance, disease prevention and protection. For more information about well checks, click here.
Common Childhood Illnesses
Find out more about illnesses common to children, tips on home treatment, and when to call to make an appointment here.
Newborn Resources
Congratulations on the new addition to your family! For resources that can help with everything from soothing, sleeping, and breastfeeding, click here.
Vaccinations
We at RockPeds know how important it is to immunize our patients against serious, life-threatening and debilitating diseases. We also know there is a lot of information and misinformation about immunizations out there now, and it can be hard to separate fact from fiction. For evidence-based information about the safety and importance of immunizations, click here.
Kentucky Children’s Hospital Specialized Pediatric Clinics
Rockcastle Pediatrics and Rockcastle Regional Hospital partner with Kentucky Children's Hospital to provide top-notch pediatric specialty services right here in Mount Vernon, Kentucky. For more information about their services, click here.
Recommended Books
Below is a list of books that we encourage you to read. Clicking on the links below will open a window to Amazon.
- The Whole Brain Child: 12 Revolutionary Strategies to Nuture Your Child’s Developing Mind by Daniel J. Siegel & Tina Payne Bryson
- Brainstorm: The Power and Purpose of the Teenage Brain by Daniel J. Siegel
- Caring for Your Baby and Young Child: Birth to Age 5 by American Academy Of Pediatrics
- Nursing Mother's Companion by Kathleen Huggins
- American Academy of Pediatrics Guide to Your Child's Sleep: Birth Through Adolescence by American Academy Of Pediatrics
- The Out-of-Sync Child Has Fun, Revised Edition: Activities for Kids with Sensory Processing Disorder by Carol Stock Kranowitz
- The Strong-Willed Child: Birth Through Adolescence by James C. Dobson
- A Parent's Guide to Gifted Children by James T. Webb
Recommended Websites
Patient Forms
Expedite your wait time in the office. Download our patient forms.
Phone:
General Inquiries: (606) 256-4148, option 1, option 1
Appointments: (606) 256-4148, option 1, option 1Nurse: (606) 256-4148, option 1, option 2
Email: rockpeds@rhrcc.org
Monday – Friday
8:00 am – 4:30 pm