Become a Patient

Become a New Patient

We are currently accepting new patients into our practice. Thank you for considering us. To become a new patient:

  1. Make an Appointment
  2. Sign up for our patient portal
  3. Download your patient forms online through the patient portal

When you come to our office for the first time as a new patient, we'll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment.

To make sure there are no delays in care during your first visit experience, please arrive 15 minutes prior to your scheduled appointment to ensure your registration is complete before meeting with your new provider.

Remember to bring:

  • Your insurance card
  • Valid photo ID
  • List of current medications
  • Office co-pay

In an effort to respect the time of all of patients, our staff strives to stay on schedule so that other patients do not have to wait.

For patients who are delayed and arrive late for appointment, every effort will be made to see them the same day. However, wait times may apply, or appointments may need to be rescheduled.

Privia portal email example

Patient Forms

New Patient Application (PDF) – We must have this form completed before we can schedule any new patients with any of our providers. Please print and fill it out, OR you may save as a document and complete, then return to our office by dropping it off, scan/saving and emailing, or fax it to 276.666.0400. After a couple of business days, you may call the office to check the status of scheduling an appointment.

Registration Packet (PDF) – The form you will need to fill out on your first visit to our office. If you would like to fill it out before your visit in order to save time, please download it, print it out, and fill it out with as much information as you can. Then bring it with you to your appointment. If you have any questions while filling out the form, please call our office, or ask us when you come in.

Authorization for Release of Medical Information (PDF) – Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Authorization and Consent for Treatment (PDF) – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.

Preferred Contacts (PDF) – Patients are encouraged to complete and return the Preferred Contacts Form but it is not required.

Athletic Participation/Parental Consent/Physical Examination Form (PDF)

Office Policies

Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

HIPAA Privacy Notice