Patient Forms
Preparing for your appointment just got easier. Here you’ll find all the forms you need ahead of your visit—saving you time and streamlining your check-in process.
Provides essential details about your personal and medical history.
(Pages 1-6 from the New Patient Packet.)
Grants permission for the clinic to provide medical care and treatment.
(Page 7 from the New Patient Packet.)
Allows the clinic to share your medical records with designated individuals or organizations.
(Page 8 from the New Patient Packet.)
Authorizes someone to access your medical information on your behalf.
(Pages 9-10 from the New Patient Packet.)
Acknowledges payment responsibility and receipt of privacy rights information.
(Pages 11-13 from the New Patient Packet.)
ACCEPTED INSURANCES
We accept most major insurance plans:
Anthem BCBS
Aetna
Cigna
Intermountain Health
- Alignment Health
- Humana
- Scan
- Select Health
- United Health
Medicaid
Medicare
Don’t see your insurance listed? Please call our office and our team can help confirm whether we are in-network with your plan.
No insurance? Ask us about our Cash-Pay rates.