New Patient Forms
New Patient Information
It is not a requirement to have a referral, but you may obtain a referral form from your family physician, specialist, or clinic.
To schedule an appointment call the CRC at (801) 375-2041.
New Patient Forms
Income Verification Form (English and Español)
Patient Intake Form (English)
Patient Intake Form (Español)
Waiver and Release of Liability Form (English)
Waiver and Release of Liability Form (Español)
Authorization for Release of Information (English)
Authorization for Release of Information (Español)
Physician Referral Form