Request an Appointment

Online 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. A scheduling coordinator will be in contact with you within 2 business days to coordinate your appointment date and time. Knoxville Dermatology Group’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*

—KnoxvilleSevierville

Desired Appointment Provider

—Lee B. Dittrich, M.D.Matthew C. Hanggi, M.D.George C. Keough, M.D.Susan Freeberg, M.D.Kimberly D. Vincent, MDAngela Smith, FNP-BCPaul Maben, PA-CAmy Browning, PA-CKatie Hageman, PA-CTammie Wampler, PA-CAshley Pierson, PA-C

Brief Description of the Nature of Your Visit*

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