Patients

List the name and date of birth for each child in your family who is a patient.

How many children in the family are patients?

Patient Portal Access

Access to records is available for all children under 18 years of age. When a patient turns 18 years old in the State of Tennessee, by law, their record automatically becomes private. They may grant permission to a parent or guardian to access their chart by signing an additional release form.

Please list the name and email of the parent/guardian that would like access to the patient portal.

Parent/Guardian Name

First Name

Last Name

Phone Number

Email

Please enter your initials. By entering your initials you acknowledge the terms of access for children under the age of 18 stated above.

Parent/Guardian Name

First Name

Last Name

Phone Number

Email

Please enter your initials. By entering your initials you acknowledge the terms of access for children under the age of 18 stated above