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

Patient HIPAA Form

Adult Health History

Medical Records Release Authorization (as needed only)

Limited Health Information Release

Patient Rights and Responsibilities

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

2860 Channing Way,
Suite 114A
Idaho Falls, ID 83404
T:(208) 535-4565
F:(208) 535-4564


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