How to complete your intake forms
New and returning patients are asked to complete a short intake packet before their appointment. This packet gathers your contact information, insurance details, and health history so your podiatrist has what's needed to provide safe, informed care from your first visit.
There are two forms to complete, both below. The first collects your contact details, insurance, and health history. The second covers the HIPAA privacy notice, our billing policy, and the Advance Beneficiary Notice. Please complete both before your appointment — each one submits separately, so you can do them in either order.
Both forms are hosted and submitted securely by Jotform rather than being stored on this website. If you would rather not complete them online, our front desk team can send paperwork directly to you or help you finish it in person when you arrive.
What you'll need on hand
- A valid photo ID
- Your current insurance card
- A list of current medications and dosages
- Names of other physicians involved in your care, if applicable
- Any relevant prior imaging, records, or referral paperwork
Can't complete your forms in advance?
That's okay — just arrive a few minutes early so our front desk can help you finish your paperwork before your appointment. If you have questions about a specific form or field, call the office nearest you and our staff will walk you through it.
- Farmington — 473 W. Bourne Circle, Suite 2 · 801-451-7500
- South Ogden — 945 Chambers Street, Suite 3 · 801-627-2122
Reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah.