Our offices will be closed Monday May 27th in observance of Memorial Day

Patient Resources

At Bristol Surgical Associates we accept self-referrals; physician referrals; and in this changing era of managed care, participate to the extent possible with managed care organizations.

We are your advocate and will communicate with your family physician to ensure continuity of care and your full understanding of your treatment when you complete surgical convalescence.

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Patient Forms

We look forward to seeing you in our offices for your upcoming appointment. Please download and complete the appropriate paperwork beforehand, to save time during the check-in process.

New Patient Forms

Download, print and fill in before your first appointment.

Established/Existing Patient Forms

Download, print and fill in before your next appointment if it’s been more than 12 months since your last visit.

Notice of Privacy Practices (English)

Notice of Privacy Practices (Español)

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Patient Portal

Contact our offices at (423) 844-6620 to request a portal invitation. Then, you will be able to do the following:

  • Request appointments
  • Request medication refills
  • Ask an insurance question
  • Ask a medical records question
  • Ask a general question
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Cash, Credit, and Checks

We accept Cash, Credit Cards, Checks. We accept all major credit cards. (Visa, Mastercard, Discover, American Express), and have some processing fees:

  • $4.25 charge for online credit card payments
  • 3.99% for in-office credit card payments

Care Credit

We offer Care Credit as a payment option. Apply now, or ask a member of our Billing Staff for more information.


We participate with most major insurance carriers. Please make certain that you obtain the necessary referral forms from your primary care physician prior to your appointment.

It is important that you familiarize yourself with the terms and limitations of your insurance contract. As a service to you, our office staff will complete and submit claim forms to your insurance company. If you have any questions, please call and speak with our Insurance Specialist.

Please remember, payment is due at the time the services are rendered. If this is not possible please notify our Patient Accounts Specialist who will work with you to develop a payment plan that is best suited for your needs. All patient balances 90 days or older will have interest applied at 12% Annual Percentage Rate.

Ready to schedule your appointment today?

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