New patient forms:

New patients will be asked to complete several forms for collection of insurance, billing, demographic, and past medical history. All forms are required to be submitted prior to the initial consultation as well as a photocopy of your insurance card and driver license or other state issued ID. Please print the forms, complete and sign, and fax to 865-305-5001.

*Choose either Male AUA or Female PUF based on gender.

• Health history

• Patient demographics

• HIPAA

• New IC/ BPS/ CP intake form

• Medical records release

• Male AUA

• Female PUF

• Notice of privacy practices