Drs. Black and Benton Pediatrics
  • New Patients
    • General Info
    • Philosophy
    • Coparenting & FAQ
    • New Patient Forms
    • COVID-19
  • Established Patients
    • Calling After Hours
    • Insurance Glossary
    • Yearly Physicals
    • Forms and Letters
  • Contact Us / Directions

FORMS

New Patient Information

Our Location
     Office and Lab
     Accepted Insurance
     Your First Appointment

Our Philosophy of Care
     Mission Statement
​     Immunization Policy

Physicals
     ​Annual Preventive Care
     Sports

​Forms
     
Special Forms and Letters
​     Downloads

COVID-19 Adjustments

Forms

Special Forms and Letters
​Writing letters and completing forms are an inherent part of what we do.  Depending on the exact letter or form requested, you may incur a small charge.

No Charge
Shot records
School medication forms 
Sports forms presented during the yearly physical appointment
Letters between Drs. Black and Benton and referred specialists

Variable Charges
FMLA paperwork
​Sports forms not in conjunction with a yearly physical
Special reports, forms, or letters
Downloads
Download the newborn patient bundle.
Download the all ages new patient bundle.
transfer records to drs. b&b
patient registration
hipaa for ages 18+
knox county sports physical form
notice of privacy practices
Consent to treat
financial agreement
missed appointment agreement

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  • New Patients
    • General Info
    • Philosophy
    • Coparenting & FAQ
    • New Patient Forms
    • COVID-19
  • Established Patients
    • Calling After Hours
    • Insurance Glossary
    • Yearly Physicals
    • Forms and Letters
  • Contact Us / Directions