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.

Authorization to Release Information (pdf)
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)