Phone: 865-977-7110

Please PRINT OUT FORMS, FILL OUT, FAX TO US or BRING IN AT NEXT VISIT

Patient Forms
2 ways you can print

1.
Print Forms Individually

 These Forms are REQUIRED prior to office visit

A. Patient Information    B. Medical History    C. Disclosure of Information (Consent)

2.

Print All 3 Required Forms (Combined for Printing)

A, B, and C Combined

Notice of Privacy Practices
This Notice describes how Health Information about you may be used and disclosed and how you can get access to this information.
Please review it carefully. The privacy of your Health Information is important to us.
(It is not necessary to print out the Notice of Privacy Practices prior to office visit)