Forms & Policies

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Doxy Telemedicine Terms of Service Agreement

Online Bill Pay

• Pay Your Bill Now

Patient Forms

You may download and print any of the forms listed below before coming to our office. You may either bring them with you to your visit or fax them to us before your appointment.

• Privacy Practices Acknowledgement Form
• Medical Record Transfer Form
• New Patient Form
• Outgoing Medical Record Release Form
• Patient Portal Registration Form
• MKPEDS HIPAA Disclosure Authorization

Behavior & Development Forms

Vanderbilt Parent & Teacher Rating Forms for ADD/ADHD

• Parent Initial
• Teacher Initial

Practice Policies

• • Notice of Privacy Practices

• Vaccine Policy Statement