Forms:

If you will be visiting the Department of Outpatient Services for the first time, please print out and complete the forms below to expedite the registration process.

Patient Intake Form (pdf)
Notice of Privacy Acts (pdf)
Consent for Treatment (pdf)
Controlled Substances Patient Contract (pdf)
Visit Agenda (pdf)

H1N1/Infectious Disease Protocols (pdf)
Declination of Flu Vaccine (pdf)

LMU-DCOM Department of Outpatient Services
6965 Cumberland Gap Parkway
DCOM Building, Suite 203
Harrogate, TN 37752
423.869.7193 (phone)
423.869.7195 (fax)