PATIENT INFO & FORMS
Patient Forms
New Patients – Please complete and submit the following forms linked below before the first appointment.
New Patient Registration and School Medical Release – Knoxville, Cleveland, and Crossville locations.
New Patient Registration and School Medical Release-Morristown and Johnson City locations
- New Patient Registration and School Medical Release -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:
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
- PillCam™ Capsule Endoscopy Agreement Form – Please complete at least 24 hours before the test.
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.
Pelvic Floor Therapy– Please complete and submit the consent and questionnaire linked below.
HIPAA Privacy Policy–Please review
Self Pay and Good Faith Estimate Information
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.
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/Patient (if over 18) driver’s license or other photo identification
- Patient’s insurance card
- Any medications that the patient is taking in their original bottles (including over the counter medications, vitamins, supplements)
- *If you are a legal guardian, please bring appropriate legal documentation.
For the first office visit we require a parent or legal guardian at the appointment for any patient under the age of 18. 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.
