Request An Appointment

    Online Appointment Request Form

    This appointment request form should NOT be used for emergencies. If you are experiencing a potentially life threatening emergency, please call 911 immediately. Dermatology Associates of Knoxville’s online appointment request form is for routine appointments only.

    Patient’s Name*

    Date of Birth – MM/DD/YEAR*



    Best Time to Call

    Desired Appointment Day

    Desired Appointment Time

    Desired Appointment Location*

    Desired Appointment Provider*

    *Note not all providers work at each location.

    Brief Description of the Nature of Your Visit*