Lodge Wellness Center
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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 cleared for a scheduled in-clinic well visit.  Patients with an illness will be scheduled for telehealth/h2h/telephone visits.  We will continue to offer telehealth/h2h/telephone visits, curbside medication pick-ups and allergy injections by appointment only.  

Call 423-822-5158 to be screened and scheduled for in-clinic or telehealth/h2h/telephone appointments.  
Call
 423-822-5158 with any questions; if we are unable to answer, please stay on the line and leave a detailed message so we can return your call. Calls will be returned during clinic hours.  Please continue to monitor this site regularly for updates.
​
Download the directions below to access Telehealth:
lodgehealow.pdf
File Size: 72 kb
File Type: pdf
Download File


Forms for NEW PATIENTS

IMPORTANT: Please download, print and fill out attached files prior to appointment.

2020 HIPPA Information and Patient Privacy Consent
2020 Patient Health History Form
hipaa information and patient privacy consent.pdf
File Size: 73 kb
File Type: pdf
Download File

new patient health history form.pdf
File Size: 162 kb
File Type: pdf
Download File

2020 Patient Information Form
2020 Notice of Privacy Practices & Acknowledgements
patient information sheet.pdf
File Size: 93 kb
File Type: pdf
Download File

2020 Medical Release Form
authorization for release of medical records general.pdf
File Size: 184 kb
File Type: pdf
Download File

one to one notice of privacy practices and acknowledgement.pdf
File Size: 161 kb
File Type: pdf
Download File


FOR MINORS ONLY: Please download, print and fill out attached files prior to appointment.
2020 Consent to Treat a Minor
2020 Permission to Accompany a Minor
consent to treat a minor.pdf
File Size: 123 kb
File Type: pdf
Download File

permission to accompany a minor.pdf
File Size: 126 kb
File Type: pdf
Download File

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  • Home
  • Services
  • Clinic & Contact Info
  • Team
  • FORMS FOR NEW PATIENTS