Forms:

If you will be visiting the Department of Outpatient Services for the first time, please print out and complete the forms below to expedite the registration process.

Patient Intake Form (pdf)
Notice of Privacy Acts (pdf)
Consent for Treatment (pdf)
Controlled Substances Patient Contract (pdf)
Visit Agenda (pdf)
Release of Health Information (pdf)

H1N1/Infectious Disease Protocols (pdf)
Declination of Flu Vaccine (pdf)

University Medical Clinic
423.869.7193 (phone)
423.869.7195 (fax)
865-670-6199 (billing)