Patient FORMS

HIPAA Form

Patient Health History Form

Office Policies

Payment Agreement Form

Records Release

Notice of Nondiscrimination

Interpreter Services

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FINANCIAL SERVICES

State of Franklin OB/GYN Specialists accepts most major insurance plans. Please call our office to inquire about your particular insurance. We also accept self-pay patients and out of network patients and would be glad to assist you in arranging for payment of services. After services are provided, we will be glad to file claims to your insurance company on your behalf. We will assist you in making sure that your insurance pays us timely and appropriately for services we have provided to you. However, please know that ultimately you are financially responsible for payment of bills incurred.

 

Any inquiries should be directed to the Billing Department at (423) 794-1319.

 

Payment Options

 

We now offer Care Credit! Care Credit is a convenient health care financing solution that allows you peace of mind for your healthcare needs. Care Credit is a credit card for your healthcare needs that lets you enjoy the benefits of living well today, with special healthcare financing. Click here to learn more: CareCredit.com

 

Patient PORTAL

Access Your Medical Information Online 24/7

 

We’re excited to offer a new online tool that provides anywhere, anytime access to your personal health records! With our new patient portal, you can manage your health, communicate with your providers and make more informed decisions about your care – 24/7 from any computer, smartphone or tablet. Click below to register:

KEEP IN TOUCH

ADDRESS

NEED MORE INFO?

423.794.1300

301 Med Tech Pkwy Suite 200

Johnson City, TN 37604

 

We're here to help! Find the forms you need to make your visit easier below.

PATIENT FORMS

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