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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

PAY BILL ONLINE

PATIENT PORTAL

Option 2: Download and Print Off

DOWNLOAD

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.

 AARP

 Aetna

 Altius/Coventry

 AmeriBen

 APWU

 Benesys Admin

 Blue Cross Blue Shield

 Bridgespan

 Cigna

 CNIC Health Solutions

 DME

 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

 Humana

 MHBP

 Humana

 MBMC

 Medicaid – Utah

 Medicare Part B

 Meritain Health

 Railroad Medicare

 Multiplan/PHCS/Beech Street

 PEHP

 PRIME

 Select Health/Select Access

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

 STERLING

 Tricare/Champus

 United Healthcare

 University Heath Plans

 UMWA

 Wise

 US Department of Labor

 Wise

 Tall Tree

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

 
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