Consultation Request Form

Non-Urgent Consultation Request

Tennessee Retina will contact your patient within 2 business days for appointment scheduling.
If there is an urgent appointment need, please contact our office at (615) 983-6000.

BY FAX:

Non-urgent Consult Form

ONLINE:

Please fax any clinical notes or medication lists to (615) 983-6010.

* Required Fields

*Requesting Physician:
*Requesting Physician Phone:
Requesting Physician Fax:
Tennessee Retina Physician:
*Patient Name:
*Patient Phone:
Patient Alternate Phone:
*Patient Birthdate:
*Diagnosis or Reason for Consultation:
Additional Comments:
If you need confirmation of appointment details or have a preference of location and time frame needed for the appointment, please include this in the comments area.
*Authentication:
*2 + 8 =	Enter the correct answer to the math question.
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"This office runs the way every doctors' office should. Staff were amazing, so nice and extremely helpful and efficient! I couldn't be more grateful that I got the doctor I did, Dr. Thomas. He was extremely insightful, never made you feel rushed. I am so blessed and grateful I called this office and got scheduled with Dr. Thomas."

via Patient Survey

Consultation Request Form

Non-Urgent Consultation Request

Tennessee Retina will contact your patient within 2 business days for appointment scheduling.
If there is an urgent appointment need, please contact our office at (615) 983-6000.

BY FAX:

ONLINE:

Clinical Trials

Patient Portal

Learning Center

Consultation Request Form

Non-Urgent Consultation Request

Tennessee Retina will contact your patient within 2 business days for appointment scheduling. If there is an urgent appointment need, please contact our office at (615) 983-6000.

BY FAX:

ONLINE:

Clinical Trials

Patient Portal

Learning Center

Tennessee Retina will contact your patient within 2 business days for appointment scheduling.
If there is an urgent appointment need, please contact our office at (615) 983-6000.