USEFUL FORMS FOR PATIENTS

patient registration form

PAST MEDICAL HISTORY FORM

HIPAA Privacy form

PATIENT REGISTRATION FORM

Please download and complete this new patient registration form and bring with you to your first appointment along with a photo ID and your insurance card.

PAST MEDICAL & SOCIAL HISTORY FORM

Please download and complete this medical, social history and review of systems form to the best of your knowledge and bring with you to your first appointment.

HIPAA FORM

Please download and sign this privacy form and bring with you to first your appointment.

PLEASE CALL US TO SCHEDULE AN APPOINTMENT: (865) 484-9948
PLEASE NOTE THAT WE DO NOT PROVIDE EYEGLASSES OR CONTACT LENSES. VISIT YOUR LOCAL OPTICAL/ OPTOMETRIST.