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Insurance Glossary Physicals Annual Preventive Care Sports Forms Special Forms and Letters Downloads |
FormsSpecial Forms and Letters
Writing letters and completing forms are an inherent part of what we do as pediatricians. 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
Please note, we are required to update the Patient Registration and Consent form annually for every child in our practice. If you would like to fill it out before your appointment you can download it below.
Download the annually updated Patient Registration and Consent form below. Note that patients over 18 years of age require a different form. They also must fill out a new HIPAA form. |
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Need a sports physical?
If your child has had a physical within 365 days of your inquiry, the doctors will, in most cases, sign off on a sports physical. Fill out the Personal and Family History Portions of this form from Knox County and drop it by the office. We'll let you know when it's ready. In some cases you may be charged for completion of the form. |