Patient Registration Forms & Privacy Notices
If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment. Please bring the completed forms with you to your appointment.
Please print the forms linked below and return the completed paperwork at your next appointment or fill out the paperwork in the office at your next appointment. You may also fax completed paperwork to (615) 292-4633 or mail it to 2400 Patterson Street, Suite 502, Nashville, TN 37203. We require this information on the day of your appointment, so please mail timely.
- Patient Registration
- Medical Records Release
- Patient HIPAA Acknowledgement and Consent
- Financial Consent
- New/Established Patient Questionnaire
- Patient Questionnaire Summit MC
Patient Rights & Responsibilities
We respect our patients’ dignity and pride. This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan.
This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.