Dr. Mark A. Jaynes
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patient  forms

Download  and  Print  Our  Patient  Forms

Patient Forms


Printable Patient Form
File Size: 115 kb
File Type: pdf
Download File

This is the form that each of our new patient needs to fill out. To save time, download, print out, and complete this form before your appointment.

 We are also prepared to accept your personal information in electronic format. Please use the following link:
 https://www.compulinkadvantageweb.com/prod/register/accountappts/index/6976
 to fill in your information online.

​This "link" is provided by Compulink, which is an authorized and certified vendor approved to securely accept and store your personal information.

Contact Us
1506 Williams Street
P.O. Box 1069
White Pine, TN 37890
Phone: 865-674-7300

Office Hours
Mon    9:00 am - 5:00 pm
Tue     9:00 am - 5:00 pm
Thu     10:00 am - 6:00 pm
Fri       8:30 am - 1:30 pm

​Notice of Privacy Practices
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  • Home
  • Our Practice
  • Our Services
  • Patient Forms
  • Eye Care Articles
  • iProfiler
  • Location