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Call Us Today 931.647.1255
787 Weatherly Drive, Suite 200
Clarksville, TN. 37043

Patient Registration Forms

DUE TO BEING A SPECIALIST OFFICE PATIENTS UNDER THE AGE OF 18 MUST BE ACCOMPANIED BY A PARENT OR LEGAL GUARDIAN TO THE FIRST APPOINTMENT AND SURGERY.

For your convenience, and to save time upon arrival, new patients may click on the link to download new patient registration forms. Please print and fill out these forms and bring them with you to your appointment. Depending on the reason for your appointment, you may be required to complete additional forms upon arrival at our office. Click on the link below to print the form:
New Patient Forms
Referral Form

Our Policies

  • Rescheduling/No Show Policy

    If you cannot make your appointment please call our office to reschedule. There will be a $25.00 charge for every missed appointment not cancelled 24 hours in advance.

  • Insurance

    We accept most insurance, including: Tricare, Tenncare (Including Americhoice & Amerigroup), Blue Cross Blue Shield, Medicare (including many Medicare Advantage plans), and most commercial insurance companies.

    Because Dr. Richards is a specialist, your insurance may require you to have a referral from your primary care physician.

  • Insurance and Hearing Instruments

    We do not accept insurance as a form of payment for hearing instruments. We will be happy to assist you in filing your claims. We apologize for the inconvenience.

  • Financial Policy

    All co-pays, co-insurances & deductibles are due before your appointment. We do understand that medical care is expensive. Please speak with a member of our staff if you need to make payment arrangements.

  • Compliancy

    Central Tennessee Ear, Nose & Throat is HIPAA compliant and Red Flag compliant. We have taken measures to ensure the safety of your identity and medical information. For more information, request an outline of our policies and procedures.