Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Patient Forms

Please complete these forms before your first visit. It will save us time in setting up your patient file — and reduce the amount of time you spend in our waiting room.

Also, please bring with you a valid photo ID (such as a driver’s license or passport) and your current insurance card.

You may complete them online.  Or, if you prefer, there are pdf versions available to display and print.  A right-click will allow you to download the pdf’s directly to your computer.  The “full patient packet” contains all the forms in a single pdf for more convenient (although slower) display and download.

  • Full Packet: PDF
  • General and Insurance Information: PDF / Online
  • Authorization for Use and Disclosure of Protected Health Information: PDF /  Online 
  • Medical Assessment: PDF / Online (see individual links below):

Our Location

Erlanger Medical Mall
979 East Third Street
Suite C-0630
Chattanooga, TN 37403
423.267.5677

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More Info

If you need additional information, please call us at (423) 267-5677, or send an e-mail to info@goodman-gi.com.

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