Patient Forms

Are you a new patient to Christ Community? Please print and complete the forms below to bring to your appointment.

Patient Forms:

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Doctors

Text Link

Broad Avenue Dental Center

Shawna Clark

Dentist

Yousef Jefferson

Dentist

Elizabeth Rich

Dentist

Jennifer J. Wade

Dentist

Broad Avenue Health Center

Milton Davis

Pharmacist

Philip W. Habegger

Nurse Practitioner

Benjamin A. Jones

Physician Lead

Jesse Mallott

Psychologist

Andrew B. Nearn

Pediatrician

Heather Preston

Nurse Practitioner

Joye Sterots

Licensed Social Worker

Heather Stone

Nurse Practitioner

Brandon Todd

Physician

Audrey Vanwylen

Physician

East Jackson Health Center

Cynthia James

Nurse Practitioner

David Larsen

Physician Lead

Dalton G. Weaver

Physician Assistant

Frayser Health Center

Benjamin Andrews

Physician

Mark A. Dean

Dentist

Sheena Dover

Physician

Christopher Ferrand

Psychologist

Lillian Funkhouser

Nurse Practitioner

Amelya R. Hardaway

Dentist

Yousef Jefferson

Dentist

Mary Jones

Physician

Katherine Musser

Dentist

Richard Nelson

Physician Lead

Patrice Owens-Johnson

Nurse Practitioner

Timothy Potter

Physician

Tiffany Townsend

Dietitian

Stephanie N. Williams

Nurse Practitioner

Rhonda J. Winfrey

Pharmacist

Brian K. Wong

Physician

Hickory Hill Health Center

Ana Carasusan

Pediatrician

Rachel Faller

Nurse Practitioner

Annalyse G. Faulk

Physician Assistant

Maria D. Fernandez

Physician

Eric Gerlach

Dentist

Reginique Green

Physician Lead

Adriana Morales

Psychologist

Clay T. Nelson

Dentist

Gina Sabbatini

Physician Assistant

Catherine A. Schricker

Dentist

Christina B. Tran

Physician

Operation Outreach

Kelley V. Scott

Nurse Practitioner

Twyla Twillie

Physician

Orange Mound Health Center

Amy Balentine

Psychologist

Angie Childers

Physician

Candace Crane

Nurse Practitioner

John Epting

Physician

Wanda Hall-Myers

Psychologist

Katherine Barger Lund

Pediatrician

Joseph Patick

Physician

Daniel Pike

Physician Lead

Ernest R. Witherspoon

Pharmacist

Raleigh Health Center

Marissa W. Acuff

Physician Assistant

Lauren Blum

Physician Assistant

Rhakevia R. Carter

Nurse Practitioner

Joanne V. Filchock

Physician

William T. King

Dentist Lead

Travis William King

Dentist

Cute Lee

Licensed Professional Counselor

Ashley N. Matthews

Physician

Maria D. Rodriguez

Physician

Daniela Rodriguez

Physician

Scott C. Stewart

Dentist

Tyler Verdell

Physician

Zakiya D. Woods

Physician

Third Street Health Center

Sarah L. Brown

Physician

David Douglass

Pharmacist

Samuel B. Edwards

Physician Lead

Brandon Edwards

Physician

Jeremy Guy

Physician Assistant

Stephanie Hardin

Nurse Practitioner

Christopher Jackson

Physician

Rasone T. Jones

Dentist

Bethany D. Lazear

Clinical Pharmacist

Merkita Lester

Nurse Practitioner

Jaynee Pierce Nerren

Physician Assistant

Erin Peeden

Physician

Kim Potter

Physician

Tara C. Samples

Psychologist

Jessica Todd

Dentist

Women's Health Center

Patrick W. Blackburn

Obstetrician-Gynecologist

Kristin Hertler

Physician

Karinthian Hulon

Women's Health Nurse Practitioner

Karinthian Hulton-Henry

Nurse Practitioner

Justine Johnson

Physician

Katherine C. Liu

Physician Lead

Mitchell McAlister

Physician

Halle Reynolds

Nurse Practitioner

Lissa N. Roux

Nurse Practitioner