Patient Forms

Authorization & Privacy Form

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Submitted On:
Jul Wed 2015
File Size:
383.49 Kb
Downloads:
10539

Health Information Form

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Submitted On:
Jul Wed 2015
File Size:
430.18 Kb
Downloads:
9551

History & Intake Form

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Submitted On:
Sep Mon 2015
File Size:
407.57 Kb
Downloads:
9129

Medical Records Release

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Submitted On:
Jul Wed 2015
File Size:
346.83 Kb
Downloads:
5342

One Time Authorization

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Submitted On:
Aug Wed 2018
File Size:
618.10 Kb
Downloads:
1451

Patient Information Form

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Submitted On:
Sep Mon 2015
File Size:
90.03 Kb
Downloads:
9729

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Administration

Request Appointment

Office Hours

Monday – Thursday: 8:00 AM – 5:00 PM
Friday: 8:00 AM – 3:00 PM

(We are closed from 12:00 PM – 1:00 PM)

Contact Us

(423) 870-3376 Office
(423) 877-1387 Fax

C Rodney Susong MD PC
2051 Hamill Road, Suite 301
Hixson, TN 37343

Chattanooga Skin Care

Missed Appointments

Missed Appointments will be charged $50.00
Missed Surgical Appointments will be charged $100.00

See our full Missed Appointments Policy for more information.
Register for our Appointment Reminder text message system.