University Medical Clinic
University Medical ClinicLMU-DCOM Atrium

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/Demographics Form (pdf)
Notice of Privacy Acts (pdf)
Consent for Treatment (pdf)
Controlled Substances Patient Contract (pdf)
Visit Agenda (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)