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 through the provider line at (615) 997-0055.

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:
*Insurance:
*ID #:
*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:
*9 + 0 =	Enter the correct answer to the math question.
Please click the Send button only once.

"I so appreciate this entire team - I've seen Drs Wallace and Schneider - couldn't have had better care for my retinal detachment. As a nurse, I love that I am asked to confirm my DOB with each encounter. It is clear this has been hard-wired into your workflow. Everyone is friendly and professional."

via Facebook

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 through the provider line at (615) 997-0055.

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 through the provider line at (615) 997-0055.

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 through the provider line at (615) 997-0055.