Patient Forms

In order to expedite your visit to our offices and make your visit more pleasant, we have put some of our more commonly needed office forms online for you to download and fill out prior to coming in. Please contact us if you have any questions or if you would like further information.

Clinch
New Patient Information Sheet Part 1
New Patient Information Sheet Part 2

Cross Park
New Patient Information Sheet Part 1
New Patient Information Sheet Part 2

Weisgarber
New Patient Information Sheet Part 1
New Patient Information Sheet Part 2

Farragut
New Patient Information Sheet Part 1
New Patient Information Sheet Part 2

Foothills
New Patient Information Sheet Part 1
New Patient Information Sheet Part 2

Please download the appropriate form, fill it out and e-mail it back to forms@knoxpeds.com. Thank you!

Growing Healthy Study – WOW (Watching Our Weight)
We offer a weight management program to provide a long-term care approach to weight issues in children. Patient ages range from 0-21, and it addresses the individual’s weight loss needs. Participation is limited to Clinch and Cross Park patients only. Appointments are available at Clinch or Cross Park. Daytime appointments are scheduled throughout the day with any provider, and occasional night clinics will be held at Cross Park with Dr. Barbara Summers.

Growing Healthy Study Eligibility Form at KPA

Medical Forms
HIPAA (Health Insurance Portability and Accountability Act)
18-year-old Information Sheet

Bill Pay
Pay your bill online