1.801.357.7404 office@unclinic.com

Medical History Form

Please print and fill the following form for your next appointment. We have a new electronic medical record system that requires us to update all your medical histories.

Patient Authorization Form

Please print and complete this form for the use of protected health information and bring it with you to your next appointment.

New Patient Demographics

Please print and fill the following form for your next appointment. Please use black ink.

New Patient Appointment Packet

Please print and fill the following form for your next appointment. Please fill with black ink.

New Patient Arbitration Forms

Please print and fill the following form for your next appointment. Please fill with black ink.

New Patient HIPPA Form

Please print and fill the following form for your next appointment. Please fill with black ink.