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Patient Forms

Fast Access Healthcare Contents Patient Forms

 

PATIENT VISIT PAPERWORK

Demographics & Information Form (annually for all patients)

HIPAA Form (annually for all patients)

Patient Visit Form (at each visit, please)

Health Awareness Questionnaire (at each visit, please)

Vascular Health Questionnaire (at each visit, please)

Allergy Questionnaire (at each visit, please)

Women's Health Questionnaire (at each visit for ladies, please)

Men's Health Questionnaire (at each visit for gentlemen, please)

 

PCP CHANGE FORMS

Amerigroup

BlueCare

UHC

What we offer

Services

 
Our Locations

Choose your preferred location

5741 Highway 153 Suite 117, Hixson, TN 37343
423-870-8088
2372 Lifestyle Way Suite 152, Chattanooga, TN 37421
423-894-0432
15367 Rankin Ave, Dunlap, TN 37327
423-949-9200
14821 Dayton Pike Suite B, Sale Creek, TN 37373
423-497-5070
400 Stuart Rd NE Suite 1, Cleveland, TN 37312
423-303-7966
5319 Ringgold Rd Suite C, Chattanooga, TN 37412
423-664-1120
4665 Main St. Ste 2, Jasper, TN 37347
423-942-0145