Knoxville Wound Care — Wound History Form

Please fill out this form before your first visit to the University Wound Care and Hyperbaric Center. For more information, please call the center at 865-305-5510.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Wound Location(Required)

When did you first notice the wound?(Required)

Has it ever healed then reopened?(Required)

How did your wound start (wounding event)?(Required)

How have you been treating your wound until now?(Required)

Have you had any lab work done in the past month?(Required)

If yes, who ordered the labwork?

Have you tested positive for an antibiotic resistant organism (MRSA, VRE)?(Required)

Have you tested positive for osteomyelitis (bone infection)?(Required)

Have you had any tests for circulation on your legs?(Required)

If yes, where done?

Have you had any other problems associated with your wound, like infection, swelling or other issues?(Required)

University Wound Care and Hyperbaric Center
1924 Alcoa Highway
Medical Building E, Suite 40
Knoxville, TN 37920
Phone: 865-305-5510
Fax: 865-305-5515

Find a Doctor

University Wound Care and Hyperbaric Center
1924 Alcoa Highway
Medical Building E, Suite 40
Knoxville, TN 37920
Phone: 865-305-5510
Fax: 865-305-5515

Find a Doctor

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