Medication & Support

If you wish to become a patient, please complete this form and email a copy of your insurance card to assistant@knoxbehavioral.com. Also please review our financial policy.

New Patient Medication Management Form

Previous Diagnoses (If any)*

Full Name*

Date of Birth*

Main concern

Phone Number*

Preferred Provider/ Insurance Name/ Insurance Member ID*

Psychiatric/Rehab History

Email (Optional)*

By sending us this document, you are consent to sharing your personal information.

Attach Medical Records*

Attachments (0)

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Support in 3 Days

Please take a picture of the front and back of your insurance card and email it to: assistant@knoxbehavioral.com

(Note: We can only process insurance cards received via email)

Knoxville Behavioral and Mental Health Services

9129 Cross Park Dr, Ste 100, Knoxville, TN 37923

(865) 983-1899

Career Opportunities

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