Patient Forms

For your convenience some of our more commonly needed office forms are available online to download and complete. Please contact us if you have any questions or if you would like further information.

If you are interested in becoming a new patient at KPA, please call the desired office and speak with the New Patient Coordinator.

Clinch
Patient Information Sheet Part 1
Patient Information Sheet Part 2

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

Weisgarber
Patient Information Sheet Part 1
Patient Information Sheet Part 2

Farragut
Patient Information Sheet Part 1
Patient Information Sheet Part 2

Foothills
Patient Information Sheet Part 1
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