Download Patient Forms

Use the links below to save time and download paperwork before your appointment.

Deseret Family Medicine General Information

New Patient Form

Patient History Form

Pediatrics History & Physical Form

Authorization to Release Records

Patient’s Medicare Authorization

Notice of Privacy Practices Acknowledgement

How to Retrieve Your Test Results

Assignment of Benefits Form

Assignment of Patient Representative Form

Payment Policy

Payment Plan Form

What to bring to your first appointment?

1.       Completed paperwork
2.       Insurance card
3.       Driver’s license/State ID
4.       Copay (cash, credit, or check accepted)
5.       List of medications or bottles
6.       Prior medical history