innovation in targeting cancer

Forms and Policies

New Patients, please download and complete the following forms before your first visit.
You can email, fax or mail the forms to Susan Eby before your first appointment. Please complete one Release of Information form per person you would like her to stay in contact with about your treatment (i.e family members, current therapist, primary care doctor, etc.)

 New Patient Forms
 Skype Telepsychiatry Consent Forms

Medication Refills

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Contacting Ms. Eby

During usual business hours, first call her office (865-314-7002). If she is unavailable, leave a message, telling her you have an urgent problem. She checks voicemail by the end of each business day. Depending on whether she needs to triage her calls, it may take up to 24 hours to return your call. If you cannot reach her and are in an emergency situation, please call 911 or go to your nearest Emergency Department.

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Miscellaneous Fees Not Covered by Insurance

The charge for a returned check is $25. There is a fee of $10 for completion of FMLA and/or short term disability paperwork, and any letters written on your behalf for your school, lawyer, employer, or preoperative verification of health status. There is a $20 charge for copying records, unless requested by another healthcare provider. There is a $10 charge that insurance does not cover for any medication prior authorization required. If your account is referred to a collection agency for non-payment, you will be discharged from the practice and a 30% service fee will be added to your account balance.
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