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 and Print Off

form

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: Evanston, Park City, IMC Wound Clinic, Heber, and Nephi.)