MON - FRI 8 AM - 5 PM

SAT 9 AM - 11:30 AM


We’ve provided New Patient Forms to make it easier to expedite your visit with us! You may download, print, and complete the forms found below prior to your appointment. Please, bring the completed forms with you or mail them to us before your appointment.

Patient Consent & Disclosure Patient History Form Immunization Waiver Form


Our office requires a minimum of 3 business days to complete all forms: Immunization forms, school forms, camp forms, disability forms or letters requested by parents or required by the patient’s insurance. There is a $10 fee for form completion. Some forms may incur a higher fee based on complexity.

There is a $20.00 fee for copying an entire medical record. If the medical record is in storage, the charge is $30.00 for the entire record and $15.00 for immunization records. All fees will be billed to the credit card on file when forms are picked up. Due to privacy regulations, no forms can be faxed or mailed. Please contact our office for all questions or concerns.

Missed Or No-Show Appointment Charge

Our office requires 24-hour notice of cancellation of scheduled appointments. If proper notice is not given, we reserve the right to charge a no-show fee to your credit card. Unavoidable extenuating circumstances will be considered on a case-by-case basis, and the patient’s physician will make the final decision concerning the assessment of the cancellation fee.

Children's Clinic of Nashville - Green Hills, Belle Meade

4322 Harding Pike, Suite 313 Nashville, TN 37205
(615) 297-9541