New Patient Forms

New patient forms are now accessible through a secure web-portal called OpenCommunicator where patients can submit their information. Just go to the OpenCommunicator Login.

Enter your net ID and password
Enter your date of birth
Click on Forms (at left)

Available Forms:

*Consent for Treatment
*Health History Form
* Insurance Information Page
*Notice of Privacy Practices
*UTHSC Required Immunizations for Students
High Risk Tuberculosis Screening Questionnaire
University Health Services Downloadable Forms

 

Printable forms. Complete them and bring with you on your first visit:
Advance Directives Form
Medical Records Release Forms

For more information about Advance Directives, visit the Tennessee Department of Health. 

Online Portal for Refill Requests and Other Functions

Contact Us

University Health Services
910 Madison, 9th floor
Memphis, TN 38163

Appointments/General Questions

Please call: (901) 448-5630

Emergency After Hours Provider Access: (901) 541-5654

Fax: (901) 448-7255

Hours

Monday to Friday 8:00 a.m. - 5:00 p.m.
Closed daily between 1:00 p.m. to 2:00 p.m.