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New Patient Forms


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


New Patient Forms

Option 3: Download and Print off


New Patient Forms


Accepted Insurance

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.






 Benesys Admin

 Blue Cross Blue Shield



 CNIC Health Solutions


 DMBA (Deseret Mutual, Deseret Alliance, etc.)

 EMI Health – Educators Mutual

 First Choice

 First Choice

 First Health Network, EBMS

 Federal Blue Cross Blue Shield

 Focal Point

 GEHA/United Integrated Services





 Medicaid – Utah

 Medicare Part B

 Meritain Health

 Railroad Medicare

 Multiplan/PHCS/Beech Street



 Select Health/Select Access

 SelectMed (in Heber, Nephi, West Jordan, Sugarhouse & Park City)



 United Healthcare

 University Heath Plans



 US Department of Labor


 Tall Tree

 Select Med (+) listed (out of network, but accepted by the following offices: Park City, IMC Wound Clinic, Heber, and Nephi.)

Our Locations

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