Online Referral Form

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Online Referral Form

Referring Doctors

Please note: The Referral Form is for the use of doctors who wish to refer patients to our office. If you are a patient, of record, please contact us by email or call us directly.

Doctors: Please use this Referral Form to request a new patient referral appointment. Please instruct your patients to bring the necessary materials to the appointment.

Please download our Patient Referral Form

If you would like to fax the forms to our office, please do so at the following numbers:

Lenoir City Fax: (865) 988-8398

Maryville Fax: (865) 379-6323

Athens Fax: (423) 744-7033