New Patient Demographic and Medical History Form
If you live outside of Utah or Idaho your first visit must be in person at our office located at

9400 South 850 East, Suite 201
Sandy, Utah, 84094

This form takes on average 10 minutes to complete.  Once it is complete we will automatically get notified. There is a one time new patient fee of $35 due at the time of your first appointment.  

If you've already completed this form before there is no need to complete it again.  
Sign in to Google to save your progress. Learn more
Email *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Restorative Health. Report Abuse