Online Patient Forms

 Download All Patient Forms
 Financial Policy | Waiver
 Financial Policy | Payments
 Patient Information Sheet
 Patient Record of Disclosures
 Notice of Privacy Practices
 Consent to Treatment of a Minor
 Agreement to Add Child to Insurance Policy

 

Appointments                            Questions? Call (901) 432-1591

We see patients by appointment only. We have same-day appointments for acute illness, future appointments for chronic conditions which are scheduled by the nurse to assure that your appointment is scheduled in an appropriate time frame. Check-ups can be scheduled by our reception staff. Please try to make your follow-up appointments at the time you are checking out.

In order to provide timely care to all our patients, walk-ins are discouraged and will incur a $50.00 fee. Arrival more than 15 minutes after your scheduled appointment time may result in your appointment being rescheduled. Failure to show for your appointment will result in your account being billed $25.00.

Co-pays should be paid on date of service. There are no exceptions. Your insurance requires a copay for each and every visit. You must pay in full at time of service if you are paying to meet your deductible, or if you are self pay. For the uninsured, we do offer a discount if cash is paid at time of the visit. We accept all major insurance plans, except Tri-Care and Medicaid/Tenncare. Please become familiar with the benefits that your medical insurance covers. We will do our best to answer your questions, but ultimately you are responsible for payment of the services provided. Well Child visits are an essential part of good medical care for your child, but not all plans cover these. Please do not ask us to provide Well Child care without properly coding and billing for these services. We encourage vaccinations through the Health Department if not covered by your insurance plan.