Wound Care — Medical Reconciliation

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.

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Allergies/Adverse Reactions/Sensitivities(Required)

Please name all allergies (medication, food, etc.) and describe the type of reaction, such as rash, itching, difficulty breathing, etc.

List All Prescribed Medications(Required)

Please list all medications prescribed, including dose, frequency and purpose.

List All Over-the-Counter Medications(Required)

Please list all over-the-counter medications. Include dose of medication, frequency and purpose. Also, please list all vitamins and supplements, including herbal and natural.

Contact Info

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

Contact Info

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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Wound Care — Medical Reconciliation

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