Lisa Wagoner, MSN, RN, NCSN
Health Services Supervisor
lisa.wagoner@knoxschools.org
Elaine Kirkland Administrative Assistant elaine.kirkland@knoxschools.org
(865) 594-3735 phone
(865) 594-3697 fax
Parent Requests
Required Forms - Please download, and complete or scan before Submitting a New Request on the red button below.
Request to Health Supervisor
Medical Release
Consent Form
You will also need:
1. A letter from your provider stating the necessity of services and rationale for provision of services during school hours.
2. Proof of Insurance or acknowledgement of financial responsibility.
Screenshots or pictures are not accepted.
Submit a new Request
View/Edit My Requests
Private Practitioner Registration
Required Forms - Please download and complete or scan before Submitting a New Request on the red button below.
(Screenshots are not acceptable)
Confidentiality and Service Agreement
Private Practitioner Treatment Schedule
You will also need :
1. Proof of Insurance. Practitioner's name must be on the policy.
2. Background Check Information e-mail Crystal Pratt at Crystal.Pratt@knoxschools.org to schedule
3. Proof of Appropriate Certification.
4. Treatment Plan
Screenshots or pictures are not accepted.
Register as a Private Practitioner
View My Practitioner Registration
Please send a photo of the practitioner for us to create a school ID card. Send photo to lisa.wagoner@knoxschools.org