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615.883.9000 H
H

615.883.9000

Online Forms

Dr. Don Lounsbury offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Notice of Privacy Practice

Download & Print Form


Automobile Accident Questionaire - Only needed  for personal injury appointments

Download & Print Form


Assignment of Benefits - Please sign and return

Download & Print Form



Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



Download the Free AdobeReader®

Sign-up using the form or call us at 615.883.9000
to make your appointment today!

Office Hours

DayMorningAfternoon
Monday8:00 - 12:002:00 - 6:00
Tuesday9:00 - 1:00Closed
Wednesday8:00 - 12:002:00 - 6:00
ThursdayClosedClosed
Friday8:00 - 12:002:00 - 6:00
Saturday8:30 - 10:30Closed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00 - 12:00 9:00 - 1:00 8:00 - 12:00 Closed 8:00 - 12:00 8:30 - 10:30 Closed
2:00 - 6:00 Closed 2:00 - 6:00 Closed 2:00 - 6:00 Closed Closed