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First Nations Clinic

Spirit Soul Body

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Refer a Patient

Please fill out the form below to refer your patient with ease and efficiency. We will reach out as timely as possible.

Referring Provider Information

Provider's first and last name*

Office phone number*

Office email*

Relationship to the patient

Patient Information

Patient's first and last name*

Email*

Phone*

Birthday*

Month

Day

Year

Has the patient received a diagnosis of cancer?*

Please share any details that might help us get your patient the care they need as soon as possible. By submitting this form, you understand we will be contacting the patient/caregiver above. If this is incorrect, please note that in the comment box. *

Contact

First Name*

Last Name*

Email*

Phone

Type your message here...

Operating Hours

Monday-Friday: 8am to 5pm
Saturday-Sunday: Closed

1200 Paint Rock Rd, Kingston, TN 37763

(865)591-0355

contact@firstnationsclinic.com

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