University Pediatric Urology | 2100 W Clinch Ave, Suite 120, Knoxville, TN 37916 | (865)637-7290

New Patient Information

A legal guardian should accompany the child to his/her visit.

For your convenience, we have put the new patient forms below that you may download and fill out prior to your appointment.

If this is your first appointment with our office, we ask that you bring the following information with you:

  • Completed New Patient Forms
  • Current insurance card
  • Legal guardian will be asked to present a photo ID at time of visit.
  • Custody papers and/or adoption papers or birth certificate.

We ask that you arrive 15 minutes prior to your appointment time.  Late arrivals may be asked to reschedule.

If you should need to cancel or reschedule your appointment, please notify our office at least 24 hours in advance at (865) 637-7290.  Failure to cancel and/or not-show for an appointment may result in a $20.00 fee added to your account.  Last minute cancellations and  missed appointments make it difficult to serve other patients who are in need of medical care appointments.  Please help us to serve your better by keeping scheduled appointments.