Forms & Policies
New Patient Forms
Patient Questionnaires
Policies
This practice serves all patients regardless of ability to pay. Discounts for essential services are offered to uninsured or underinsured patients depending upon family size and income (sliding scale discount). Uninsured or underinsured patients may apply for a discount at the front desk or by filling out and returning the application above. Discounts must be approved prior to services.
Notice-of-Nondiscrimination_Spanish
HIPAA Notice of Privacy Practices
HIPAA Notice of Privacy Practices Spanish
On May 17, 2023, the Governor signed into law HB1380/SB111 (amendment of Tennessee Code Annotated 63.1) stating that only parents or legal guardians of minors can provide consent for vaccination. Plateau Pediatrics is offering an Advance Vaccine Consent form to families. This form, signed by the parent or legal guardian of the patient, will allow us to provide vaccinations when children are brought by stepparents, grandparents, aunts, uncles, or other alternate caregivers.
Telehealth
Is Your Child Sick?®
