Forms & Policies

New Patient Forms

Patient Registration Form – English | Spanish
Arbitration Agreement – English | Spanish
Physician Ownership Letter – English
Clinic Fee Policy – English| Spanish
Medical Records Request – English | Spanish

Clinic Policies

Patients Rights & Responsibilities – English | Spanish
Privacy Statement – English | Spanish
Patient Billing Rights – English | Spanish

Other

Billing & Payment Options – English
Frequently Asked Questions – English
Insurance Information – English
Your Visit – English
Narcotics Agreement (West Jordan Location ONLY) – English
Health HX (West Jordan Location ONLY) – English