Southern Utah Upper and Lower Back Pain Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain

 

 

Patient Information Sheets

Select the link below and print out all pages. Please fill out and bring these forms to your first appointment. The physicians rely heavily on this information during your first appointment.

Patient Information Form

(Adobe Reader or Foxit Reader Required to View the File)


BILLING AND PAYMENT POLICY

As a benefit to our patients, we are participating providers with many insurances including:

MEDICARE
EMIA
BLUE CROSS BLUE SHIELD
VALUECARE
IHC
MAIL HANDLERS
ALTIUS
PEHP

Please check your policy to see what coverage your insurance may provide for a specialist in Physical Medicine and Rehabilitation. In most cases, as a service to our patient, we will file the insurance claim. Our payment policy requires deductibles and/or co-payments are due at the time of service. We accept cash, personal checks, MasterCard and Visa. Please call of office if you have a question regarding our billing and payment policies.

Southern Utah Upper and Lower Back Pain Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain Southern Utah Upper and Lower Back Pain
Southern Utah Upper and Lower Back Pain