Call or Text: 615-758-2501

Patient Center

Welcome to our Online Patient Center! Here you can get information about what to expect during your visit with our doctors as well as important forms you can complete before your appointment to save time.

We want your visit to be as stress-free as possible. Our staff will do everything we can to make sure your experience is pleasant and convenient. If you have any questions about these forms, please don’t hesitate to contact us.

What to Expect

When you visit our office, you will be warmly welcomed and we can answer any questions you may have about completing the paperwork so that Mt. Juliet Family Vision may see you. Our team will work together to evaluate your eyes and provide relevant eye care treatment information, review your vision benefits and payment options, fit you for glasses or contact lenses, and focus on exceeding all of your expectations. If at any time you have questions about the process or your specific health information, please ask.

Patient Forms

Fill Out Mt. Juliet Family Vision Forms Online

For your convenience, Mt. Juliet Family Vision has made it possible for patients to complete patient and registration forms online from the comfort of their computer at home or on the go, patients no longer need to fill out forms by hand unless it is their preference to do so.

Online Forms

Print And Fill Out By Hand Option.

For patients who prefer to print out forms as hard copies and later fill them out by hand:

  • You will need AdobeReader® to download and complete the forms. Click the link at the bottom of the page if needed.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office (615-758-2524) or bring them with you to your appointment.

Adult Health History Form
To Be Completed For First Visit
Important Health Information

Pediatric Health History Form
To Be Completed For First Visit
Health And School History Info

Records Release Request
Recommended To Be Completed For First Visit
Records Release Authorization

Financial And Insurance
To Be Completed Before First Visit
Includes Authorizations & Releases


  • Monday
  • 7:00am - 5:00pm
  • Tuesday
  • 8:00am - 6:00pm
  • Wednesday
  • 7:00am - 5:00pm
  • Thursday
  • 8:00am - 7:00pm*
  • Friday
  • Closed
  • Saturday
  • Closed
  • Sunday
  • Closed
Closed from 12:00 - 1:00pm.
*Open at 8:45am every 3rd Thursday of the month.

First time visiting this place today & everyone was absolutely wonderful & so very kind. Dr. Kevin was so thorough and it is appreciated. They have definitely earned my business and I’ll be sure to pass the word along!
Tiffany M.

Payment Options

Mt. Juliet Family Vision believes in providing the best value for you and your family. We have products and pricing that aims to accommodate all budgets and our office participates in most insurance programs. For patients who have little or no vision insurance coverage, flexible payment programs may be arranged. To learn more about our payment options, please call our office directly.

Our office accepts cash, check, and major debit and credit cards including MasterCard and Visa, as well as Care Credit.

Don’t forget to use your:

  • Flexible Spending Plans
  • Health Savings Accounts (HSA)
  • Medical Savings Accounts (MSA)
  • Cafeteria Plans for most of your eye care needs

All of the above plans can be used for all your eye care and eyewear needs, including eyeglasses, contact lenses, routine office visits and medical office visits.


Since there are so many plans and coverage varies widely, please call us to find out if your plan covers care in our office. Our staff will verify and explain your benefits before your visit at no charge.

Contact Us