Make an Appointment

Please fill out all the requested information and then click the SUBMIT button. Someone from our office will contact you within one (1) business day.

To ensure efficient and prompt patient care, it is requested that each patient have current imaging prior to scheduling an appointment (MRI,CT,X-rays,...etc).

Once an appointment has been scheduled, appointment information will be faxed to the referring provider and we will contact the patient with the date and time of their appointment.

Please note that our practice does not accept Cover TN, TLC, VHP, Unisys, Windsor Medicare, UAHC, and Auto Insurance.

If there are any questions about scheduling please contact Maygan Chase at (615)986-1256 ext. 171.

 

* indicates required fields 
  *Patient Name:
  *Sex:
  *Date of Birth:
  *SS#:
  *Patient's Phone #'s:
  *Diagnosis:
  *Insurance Company:
  *Policy Number:
  *Group Number:
  *Referring Provider's Name:
  *Mailing Address:
  *Contact Person:
  *Return Phone #:
  Fax #:
  UPIN:
  NPI:

Please click on the Submit button to submit the above form.
 

Decisions regarding clinical care should not be based upon information contained on this website.  This website is not intended to replace the patient physician relationship.  If you have any questions regarding the diagnosis or treatment of your medical condition please contact your physician or Dr. Li at (615)986-1256.
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