The Patient Registration Form must be completed prior to your first visit. We are a Federally Qualified Health Center (FQHC), and are required by Federal law to collect some of the information asked in the packet for statistical purposes only. This is reported annually on a total patient basis. Individual patient information is not reported or disclosed.
Our providers desire to make your first visit with us a success and are interested in learning as much as possible about your current health status. Please come prepared to talk about your health history with your new provider. Please bring your signed patient information form, photo ID and all of your bottles of all medications you are currently taking.
If you are insured with TennCare, Medicare or private insurance, please bring your insurance card and photo ID. To qualify for the sliding fee discount a signed sliding fee application will also need to be submitted.
Please complete both sides of the forms. Thank you for your cooperation, and we look forward to serving you.
The Nurse Practitioners and Staff of the ETSU Community Health Centers
2151 Century Lane
Johnson City, TN 37604
Phone: (423) 926-2500
Fax: (423) 926-5999
Hours of Operation:
Note: New patients accepted, Please call to schedule an appointment.
Monday 8:00 am – 6:00 pm
Tuesday 8:00 am – 6:00 pm
Wednesday 8:00 am – 8:00 pm
Thursday 8:00 am – 6:00 pm
Friday 8:00 am – 6:00 pm
Saturday 8:00 am – 12:00 noon
Public Transportation Info:
Red Route: West Market St. Bus Stop. Runs at :23 after the hour.