New Patient Forms
Click the link below to enter your medical and insurance information. Please fill out as detailed as possible. If you are unable to connect via the patient portal, then download the paperwork, print it off, fill out and bring with you to your appointment.
Option 1 (Preferred): Login Online to fill out New Patient Paperwork
Option 2: Download, fill out digitally. Then print and bring to your appointment with you, or save as a document and email to email@example.com.
Option 3: Download and Print off
As a service to our patients, we bill most insurances. Below is a list of the most common insurances we take. If your particular insurance is not listed below, there is a great chance that you would still be covered in our offices. However, it is best to check with your insurance prior to scheduling an appointment.
Blue Cross Blue Shield
CNIC Health Solutions
DMBA (Deseret Mutual, Deseret Alliance, etc.)
EMI Health – Educators Mutual
First Health Network, EBMS
Federal Blue Cross Blue Shield
GEHA/United Integrated Services
Medicaid – Utah
Medicare Part B
Select Health/Select Access
SelectMed (in Heber, Nephi, West Jordan, Sugarhouse & Park City)
University Heath Plans
US Department of Labor
Select Med (+) listed (out of network, but accepted by the following offices: Park City, IMC Wound Clinic, Heber, and Nephi.)