tennessee patient care report form

New Patient Registration Forms

We strive to provide our patients with quality care in a timely manner. To help minimize your time in our office, you may securely submit your patient registration forms online prior to your visit. Please allow 1 full business day for forms submitted online to process.

Financial Assistance

Your retina care is important, and we have many options to help ease the burden of financial hardship. Please contact one of our financial counselors to review your options.

Medical Records Request

If you would like to request for us to send or receive your medical records, please print and fill out the Medical Records Release Form below.

What is the right to report a health care provider?

However, when a problem is experienced with either a health care professional or health care facility, you have the right to report them. If you believe the practitioner or facility’s behavior or care is not acceptable, you may file a complaint with the Department of Health.

What is the state of Tennessee?

The state of Tennessee is graced with some of the finest health care professionals, educational institutions, postgraduate programs and health care treatment facilities in the United States. The majority of health professionals are competent, caring individuals. Most persons are satisfied with the level or quality of care they receive. However, when a problem is experienced with either a health care professional or health care facility, you have the right to report them. If you believe the practitioner or facility’s behavior or care is not acceptable, you may file a complaint with the Department of Health.

How to contact Centralized Complaint Intake Unit?

Centralized Complaint Intake Unit. You may phone your complaint to one of our medically trained staff by contacting Health Care Facilities, Complaint Intake Unit. The call will be toll free and phones are answered Monday through Friday, 8:00 a.m. – 4:30 p.m. Simply dial this toll-free number: 1-877-287-0010.

How to report opioid abuse?

Effective January 1, 2019, reports by employees of any entity that prescribes, dispenses, or handles opioids of suspected opioid abuse or diversion shall be accepted by the health professional licensure boards by calling the Complaint Intake Hotline at: 1- 800-852-2187.

Is the name of the complainant confidential?

Although the Department may, upon request, be required by law to release basic information about a specific complaint, the name of the complainant, if known, is always kept confidential.