New Patients - GI for Kids

NEW PATIENT INFO

You may contact our office Monday through Friday from 8:00 a.m. to 4:15 p.m. at (865) 546-3998 to make an appointment.

Before your first office visit, please print and fill the new patient forms below. You only need to fill out New Patient Nutrition Packet if seeing the Registered Dietitian.

Patient Forms

New Patients – Please complete and submit the following registration form before your appointment and the school release if you/your child is in school:

- New Patient Paperwork-Online
- School Release-Online

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

Medical Release
- Medical Release Form-Online

Allergy Scratch Testing Information and Consent Form
- Allergy Scratch Testing Information & Consent-Online

Bravo Agreement- Please complete and submit this form at least 48 hours before your child’s procedure:
- Bravo Agreement-Online

Dietitian New Patient Packet- Please print, complete, and bring this packet with you to your first appointment with the dietitian:
- Nutrition New Patient Packet

Healthy Lifestyle Clinic- Please complete and submit the first two (2) forms and then print, complete, and bring the Questionnaire to your first appointment in the Healthy Lifestyle Clinic:

HIPAA Privacy Policy-Please review
- HIPAA Privacy Policy

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 for any of our providers, locations, and/or specialty clinics.

- New Patient Quick Online Provider Referral
- New Patient Referral Form- Fillable PDF

Motility and Heartburn Clinic Referral Form- Please complete this form for specialty testing and fax to our office at 865-546-1123:
- Motility and Heartburn Clinic Referral Form

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.

Please Bring The Additional Following Items:

Parent’s driver’s license
Child’s insurance card
Child’s social security number
Any prescriptions that the child is taking in their original bottles
**If you are a legal guardian, please bring appropriate documentation

For the first office visit we require a parent or legal guardian bring the child. For future appointments, another individual may bring the child as long as the parent has given written consent ahead of time. That individual is required to bring photo identification. This consent can be found at the bottom of the first page of the new patient forms.

About Us

Patient Info

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NEW PATIENT INFO

Patient Forms

New Patients – Please complete and submit the following registration form before your appointment and the school release if you/your child is in school:

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:

Medical Release

Allergy Scratch Testing Information and Consent Form

Bravo Agreement- Please complete and submit this form at least 48 hours before your child’s procedure:

Dietitian New Patient Packet- Please print, complete, and bring this packet with you to your first appointment with the dietitian:

Healthy Lifestyle Clinic- Please complete and submit the first two (2) forms and then print, complete, and bring the Questionnaire to your first appointment in the Healthy Lifestyle Clinic:

HIPAA Privacy Policy-Please review

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 for any of our providers, locations, and/or specialty clinics.

Motility and Heartburn Clinic Referral Form- Please complete this form for specialty testing and fax to our office at 865-546-1123:

Please Bring The Additional Following Items:

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INFO CENTER

CONTACT US

(865) 546-3998