State of Tennessee

To schedule an appointment with one of our telehealth providers fill out the information below, and we will contact you.

Preferred Language

County you live in or go to school

Have you been to a local health department within the past year?

Yes No

You will need to contact your local health department clinic in order to determine if you are able to be seen via telehealth

Name

First Name

Last Name

Phone

Is it okay if we contact you via text

Yes No

Best time to contact

Morning Afternoon Evening