• News & Upcoming Events
• Available Services
  • Primary Care
  • Pharmacist
  • Massage Therapist
  • Nutrition Counseling
• UTHSC Employee Health
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  • Non-Work Related Injury/Illness
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  • Occupational Health Links
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• BCHS Students
  • Primary Care Services
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  • Student counseling
  • BCHS New Student Health Form
• TB Screening
• UTHSC Residents/Post-Docs
  • Primary Care Services
  • Mental Health Services
  • Immunization Form
  • TB Reading Form
• Travel Clinic
• Emergency
• Health Links
  • Mental Health
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• FAQs
• Injuries & Exposures
• New Patient Forms
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• AAAHC Accreditation

New Patient Forms

Print the forms, complete them and bring with you on your first visit.

Patient Registration Form (71KB PDF)

UHS Authorization (12KB PDF)

UHS HIPAA (158 KB PDF)

Health History (76KB PDF)

For Occupational Health Patients:

OSHA Respirator Medical Evaluation Questionnaire (Mandatory) (99KB)

Contact UHS

910 Madison Ave. Suite 922
Memphis, Tennessee 38163
Phone: 901-448-5630
Fax: 901-448-7255