CLARKSVILLE CLINIC
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New Patient Forms   

ATTENTION: Important Clinic Information

Due to requirements related to COVID-19, we are screening and re-screening all patients.  Patients with negative screenings may be scheduled for an in-clinic visit.  Other patients will be scheduled for Telehealth visits.  We will continue to offer Telehealth visits, curbside medication pick-ups and allergy injections by appointment only.  ​
Call 615-346-9437 if you have any questions or to be screened and scheduled for an in-clinic or Telehealth appointment.  If we are unable to answer, please stay on the line and leave a detailed message so we can return your call.  Messages are monitored 24/7.  Please continue to monitor this site regularly for updates. ​​​​
Download the instructions to access Telehealth. 
Telehealth Instructions

New Patient Forms   

For your convenience, please download, print, and complete the following forms prior to your appointment.  Bring the completed forms with you to your first in-clinic appointment. 
New Patient Health History Form
HIPAA and Privacy Consent Form
Patient Information Sheet
Notice of Privacy Practices
For Minors Only: 
Consent to Treat a Minor
Permission to Accompany a Minor

We look forward to taking care of you soon. 

130 N. Spring Street | Clarksville, TN 37040 
Phone: 615-346-9437 | Fax: 615-291-1702 | Email: patientservicesclarksville@121.health
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  • Home
  • Services
  • Patient Portal
  • Wellness
  • Telehealth
  • Forms for New Patients
  • Team
  • Contact Info