Patient Forms

If you are a new patient, please fill out the registration forms below and bring them with you when you come for your appointment.

Registration Forms

Patient Registration

Patient Consent

Health Questionnaire

Medical Records Release Authorization (as needed only)

Limited Health Information Release

Privacy Notices

This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Notice of Privacy Practices

Aviso Sobre Las Practicas Privacidad

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Located west of the Eastern Idaho Regional Medical Center Emergency Room

 
 Office Hours:
Monday - Thursday
9am - 5pm
Fridays 9am - 3pm