University Pediatric Urology

Patient Information

Please print and complete the forms located below prior to your first appointment to ensure a quicker and safer visit.

To schedule an appointment at our office, please call

(865) 637-7290.

If you are making a new patient appointment, please have the following information available:

  • Patient name 

  • Date of birth

  • Insurance information

  • Contact number

  • Reason for visit

We ask that all patients arrive 15 minutes early to their appointment. Late arrivals may be asked to reschedule. If you should need to cancel or reschedule your appointment, please notify our office at least 24 hours in advance at (865) 637-7290.  Failure to cancel and/or not-show for an appointment may result in a $20.00 fee added to your account.  Last-minute cancellations and missed appointments make it difficult to serve other patients who are in need of medical care appointments.  Please help us serve you better by keeping scheduled appointments.



PLEASE bring a physical copy of any imaging (XRAYS, ULTRASOUNDS, CT SCANS, ETC.) done at an outside facility.  Failure to do so may result in a delay in treatment.

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New Patients

If this is your first appointment with our office, we ask that you bring the following information with you:

  • Completed New Patient forms
  • Current insurance card
  • Legal gaurdian MUST be present and will be asked to present photo ID at time of visit
  • Custody papers and/or adoption papers or birth certificate