Forms and Downloads

Save time! Complete the registration form at your leisure, then bring it on your next visit!

 

 

New Patient Registration Form – English

 Please bring the following:

  1.  Your registration form filled out.
  2. Your insurance card (if you have insurance).
  3. A paycheck stub if you are self-pay or want to take advantage of our sliding fee discounts (based on family size and income).
  4. For Intermountain lab vouchers, they require income verification and utility bills (as proof of Utah residency) for their voucher program.

Print out this form if you want to give pre-authorization so that medical care can be delivered directly to minors if a parent or legal decision maker cannot be present prior to treatment