Patient Information and Forms

• • New Patient Paperwork-Knoxville, Cleveland, and Crossville locations

  • New Patient Paperwork -Morristown and Johnson City locations 

  • New Patient Paperwork -Corbin, KY 

• Pacientes nuevos: Complete y envíe el siguiente formulario de registro antes de su cita y el permiso escolar si usted/su hijo está en la escuela:

  • Registro de Paciente Nuevo

  • Liberación de la escuela

• School Release Form

• Medical Release Form

• Allergy Scratch Testing Information and Consent Form

• Bravo Agreement Form– Please complete and submit this form at least 48 hours before your child’s procedure

• PillCam™ Capsule Endoscopy Agreement Form – Please complete at least 24 hours before the test.

• PillCam™ Capsule Endoscopy Consent
  

• Dietitian New Patient Packet– Please click the link, print and complete packet, and bring it with you to your first appointment with the dietitian.

• Healthy Lifestyle Clinic– Please complete and submit the forms linked below before the first appointment.

  • Healthy Lifestyle Clinic Paperwork

• Pelvic Floor Therapy– Please complete and submit the consent and questionnaire linked below.
  

  • Pelvic Floor Therapy Paperwork

• HIPAA Privacy Policy–Please review

• Insurance Waiver

• Good Faith Estimate for Self-Pay Patients

  • Self-Pay Rates

Provider Office Forms:

Submit your referral quickly online or download a fillable PDF version and fax to our office at 865-546-1123.

You can use either of these forms to submit a new patient referral form for any of our providers, locations, and/or specialty clinics.

• • New Patient Referral Form- Fillable PDF

NOTE: Adobe Acrobat® reader is required to view and print some of these forms. If you do not already have Adobe Acrobat® reader installed, you can download it here.