(423) 929 - 9101
2340 Knob Creek Road Suite 704 Johnson City, TN
Forms & Notices

Save Yourself Some Time!

Please print, complete, and bring these forms with you to your appointment. We look forward to seeing you!

Patient Registration Form pdf-icon

HIPAA Authorization Consent Formpdf-icon

Patient Health History Formpdf-icon

Minor Patient Treatment Consent Formpdf-icon

Notice-of-Privacy-Practicespdf-icon

Release of Healthcare Information Authorizationpdf-icon

Notice of Nondiscriminationpdf-icon

 

No printer? No problem – we can mail these forms to you, just call (423) 929-9101 or Email your request to ContactUs@ENTJC.com and we will be happy to accommodate.

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