Forms / Scheduling

Dr. Potter is glad to review the basics of your case if you would like to be sure that he can offer help with your condition.  Once you decide to schedule an appointment you will need to complete both online forms and digital / paper forms.

1)  You will click the link further below to enroll in my Electronic Medical Record. The final page requires a credit/debit card number. This will not be charged until you agree.

2) Complete a more detailed “SMCC New Patient Form” (Word Format SMCC New Patient Form DOC or PDF editable SMCC New Patient Form PDF ). This provides lifestyle, nutritional, and otherwise “whole-person” background information which makes our first visit more efficient. You can either print the form (Word format, PDF), complete the questions in ink, and fax/scan OR you can complete on computer document (Word, PDF Form) and email as attachment. Please complete #1 and #2 above 2 weeks prior to visit if possible.

3) Print HIPAA Consent SMCC off website (Legal Page). List who you want to receive messages concerning your health from me and sign. Fax or email a scan back prior to appointment. The HIPAA consent: 1) acknowledges that I have offered you a copy of my HIPAA security policy, 2) allows you to list persons who may receive messages in case I need to contact you, 3) grants me permission to communicate with you by way of non-secure means such as voice mail and email.

4)  Request a SMCC Consult Agreement” by email.  You may do so by sending your contact information and date of birth on the contact form or email smccpatient@postpro.net).

5) Fax (615-301-4063) or email (drpotter@sanctuarymedicalcare.com) records (please include labs, xray reports, CT/MRI/ultrasound reports, recent specialist record if available that pertain to your current issue requiring my consult.)

Dr. Potter looks forward to caring for you.