Please use the following link to download a

Please fill this out and bring it with you to your appointment to speed up your check-in process.  We'll also need one form of ID (Driver's License, or passport, or green card, etc.) and your insurance card.  Also we'll need a paycheck stub if you want to take advantage of our sliding fee discounts (based on family size and income).  For Intermountain labs, they require income verification and utility bills (as proof of Utah residency) for their voucher program.

Hoja de Registro del Paciente

This link opens in a new window Hoja de Registro del Paciente (1.49 MB Adobe pdf file)

Por favor llenarlo y traerlo en su poxima cita.

Para imprimir una copia del PDF usted necesita instalar el programa Adobe Acrobat Reader en su computadora. Si usted no tiene el programa de Adobe Acrobat instalado en su computadora y le gustaría obtenerlo, Esta liga se abre en una ventana nueva eoprima aquí para obtener una copia gratis de Adobe Acrobat Reader.

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

You will need adobe reader software to open this document.  Please follow this link to obtain the software free of charge:

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. 
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