HAMBLEN PEDIATRIC ASSOCIATES, INC. & HOMETOWN PEDS
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FORMS

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What to bring?

-If you are not the biological parent, please bring a copy of the guardianship court papers.
-Insurance cards
-All prescription medications

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New Patient Forms

  • If you are a new patient, you will be asked to fill out several new patient forms for our office records.
  • You can save some time by filling these forms out at home and bringing them with you during your first office visit.
  • Please let us know if we can help answer any questions regarding the forms. We look forward to serving you!
Patient Registration
File Size: 68 kb
File Type: pdf
Download File

Initial History Questionnaire
File Size: 166 kb
File Type: pdf
Download File

Missed Appointment Agreement
File Size: 46 kb
File Type: pdf
Download File

Financial Policy
File Size: 71 kb
File Type: pdf
Download File

Patient Consent for Medical Treatment
File Size: 54 kb
File Type: pdf
Download File

Notice of Privacy Practices
File Size: 221 kb
File Type: pdf
Download File

2018 Authorization for Disclosure of Medical Information
File Size: 60 kb
File Type: pdf
Download File

Authorization of Consent for Minor Child
File Size: 204 kb
File Type: pdf
Download File

Consent for Healthcare Messages
File Size: 188 kb
File Type: pdf
Download File

** Need adobe reader? Download here
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Current Patient Forms

  • If you are a current patient and have not visited our office within the past year, you will be asked to fill out the Update Patient Data form.
  • You can save some time by filling these forms out at home and bringing them with you during your first office visit.
  • Please let us know if we can help answer any questions regarding the forms. We look forward to serving you!​
Patient Registration
File Size: 68 kb
File Type: pdf
Download File

Missed Appointment Agreement
File Size: 46 kb
File Type: pdf
Download File

Financial Policy
File Size: 71 kb
File Type: pdf
Download File

Patient Consent for Medical Treatment
File Size: 54 kb
File Type: pdf
Download File

Authorization of Consent for Minor Child
File Size: 204 kb
File Type: pdf
Download File

Consent for Healthcare Messages
File Size: 188 kb
File Type: pdf
Download File

Authorization of Consent for Minor Child
File Size: 204 kb
File Type: pdf
Download File

Consent for Healthcare Messages
File Size: 188 kb
File Type: pdf
Download File

** Need adobe reader? Download here

Additional Forms -  Please download, print, and fill out if it pertains to your needs.
Sports Physical Evaluation Form
File Size: 256 kb
File Type: pdf
Download File

Portal Information
File Size: 207 kb
File Type: pdf
Download File

Patient Centered Medical Home information sheet
File Size: 263 kb
File Type: docx
Download File

Patient Information Handout
File Size: 264 kb
File Type: docx
Download File

COMPANY
About
New Patients
Current Patients
Hours & Locations
Careers
Discrimination Policy
​Code of Commitment

We are here for you 24 / 7


A Physician is on call 24 hours per day, 7 days per week.  Call Morristown (423) 581-3904, Jefferson City (865) 475-5377, or Sevierville (865) 453-9980, and you will be connected to our answering service.  A nurse from our Pediatric answering service will return your call. If you have not received a call back within 30 minutes, please call the answering service again. After hours is for emergencies or acute illness questions - not for routine questions which can be answered during regular business hours. 
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Download Code of Commitment 
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Copyright Hamblen Pediatric Associates, Inc.  |  Morristown. Jefferson City. Sevierville.
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  • Home
  • COVID-19 ALERT
  • About
    • Our Story
    • Our Providers
    • Mission Statement
  • New Patients
  • Current Patients
  • Resources
    • Patient Education
    • Patient Portal
    • Immunization Schedule
    • Video Library
    • Helpful Links
    • Discrimination Poster
  • Contact
    • Hours & Locations