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*

Phone*

Email*

Best Time to Call

---MorningAfternoonEveningNo Preference

Desired Appointment Day

---MondayTuesdayWednesdayThursdayFridayNo Preference

Desired Appointment Time

---morningafternoon

Desired Appointment Location*

---Dowell Springs OfficeFarragut OfficePowell OfficeUT Medicial Center Office

Desired Appointment Provider*

---Edward J. Primka, III, M.D.Drew W. Miller, M.D.Elizabeth Ergen, M.D.Misty Hammond, DNPMelissa Headrick, NP-CSandra L. Vaughn, NP-CKevin Blazer, PA-CCameron Stengel, PA-CBlake Childress, PA-CLauren Church, PA-CSharon McNutt, PA-CMarcus Ortiz, PA-CJennifer Webster, PA-C
*Note not all providers work at each location.

Brief Description of the Nature of Your Visit*