New Patient Packet

Please print off this New Patient Packet, fill out the information, and bring it with you to your appointment.

New Patient Packet: Microsoft Word Format

New Patient Packet: Rich Text Format

New Patient Packet: PDF Format

Bureau of Primary Care, Utah Department of Health (UDOH)
Mailing Address: PO Box 142008 Salt Lake City, UT 84114-2008 | Location: 3760 S Highland Dr. Salt Lake City, UT 841061
Email: utclinics@utah.gov | Phone: 801-715-3500 | Fax: (801) 273-4150
Clinic Website: health.utah.gov/clinics/healthclinicsofutah.html
Bureau Website: health.utah.gov/clinics