Signing a Contract

Forms

Referral Form

To request consultation or testing, fill our

referral form

and fax to:

801-281-5960.

You can also use our secure online referral form.

Registration

Fill out the registration form prior to your visit to speed the check in process.

Medical Records

Send a signed copy of our Medical Release of Information to every facility where you have been treated.

More information regarding medical records here.

Handicap Parking

Review and sign our service agreement to speed the check in process.

Privacy Statement

Handicap Parking

If you need a handicap parking permit, fill out the form and give it to us for medical signature.