Skip to main content

  • About Us
    • History
    • Caring for our Community
    • Departments/Services
    • Office Locations
    • Forms
    • Site Map
    • Outreach Clinics
  • Services
    • Physician Services
      • Cancer Center
      • Cardiology
      • Dermatology
      • Ear, Nose & Throat
      • Endocrinology
      • Gastroenterology
      • Imaging/Radiology
      • Infectious Diseases
      • Internal Medicine
      • Nephrology/Chronic Kidney Disease
      • North Valley Orthopedics & Plastic Surgery
      • Orthopedic Specialty Center
      • Sports Medicine
      • Urology
    • Clinical Research
    • Diagnostic Services
      • Cardiac Diagnostics
      • Imaging/Radiology
      • Laboratory
      • Osteoporosis
      • Sleep Disorders
    • Therapeutic/Surgical Services
      • Cancer Treatment
      • Cardiac Cath Lab
      • Sports Fitness & Physical Therapy
      • Surgery Center
    • Preventive/Support Services
      • Cancer Support
      • Diabetes Education
      • Wellness Institute
    • Insurance and Billing Information
    • iHealthRecord Login
  • Physicians
    • Cancer Center
      • Blair, TJ
      • Bott, J Cordell
      • Breyer, Wendy
      • Brown, Richard
      • McAllister, Bruce
      • Tudor, Brian
      • Wallentine, Steven
    • Cardiology
      • Allen, Marvin
      • Badger, Rodney
      • Bingham, Scott
      • Carter, M. Eric
      • Cragun, David
      • Dahl, Charles
      • Frischknecht, John
      • Hwang, Chun
      • Smith, Douglas
      • Walker, Jerry
    • Dermatology
      • Bradshaw, Brian
      • Donaldson, Mark
      • Peterson, Ray
    • Ear, Nose & Throat
      • Ence, B. Kelly
      • Gibb, Randal
    • Endocrinology
      • Maturlo, Susan
    • Gastroenterology
      • Alsolaiman, Mohammad
      • Bodily, Kurt
      • Craner, Gregory
      • Dickinson, Thomas
      • Hemmert, Wynn
      • Karnam, Uma
      • Thorpe, Brett
    • Infectious Diseases
      • Abolnik, Igor
    • Internal Medicine
      • Al-Shuqairat, Tala'at
      • Anderson, Kirk
      • Bennion, David
      • Brown, Mark
      • Corniea, Robert
      • Curzon, Sean
      • Duros, Peter
      • Fonseca, Walstir
      • Huddleston, Jason
      • Jeffery, Allan
      • Johnson, Jeffrey
      • LeRoy, E. William
      • Ling, Yun
      • Marshall, Kent
      • Nobuhara, Lawrence
      • Olsen, Richard
      • Sires, Mazen
      • Staheli, John
    • Nephrology/Chronic Kidney Disease
      • Gurau, Izabella
      • Hammond, Terry
      • Stephanz, Gerald
    • Neurology
      • Groves, Jeffery W.
    • North Valley Orthopedics & Plastic Surgery
      • Banks, Alan
      • Callahan, Michael
      • Ritchie, Paul
      • Sanderson, Mark
      • Wells, John
    • Orthopedic Specialty Center
      • Bacon, C. William
      • Colledge, Alan
      • Faux, J. Robert
      • Jackson, Richard
      • Jackson, Robert
      • Jackson, Scott
      • Johnson, Curtis
      • Kimball, Kirt
      • Larsen, Mitchell
      • Nelson, DeVon
      • Richards, Ryan
      • Richey, Joseph
      • Wallentine, Jeffery
      • Weenig, Karl
    • Radiology/Imaging
      • Gledhill, Kent
      • Green, Stanley
      • Layton, Brent
      • Smith, Gregory
      • Valadez, Scott
      • Watters, David
      • Wright, Dalton
    • Sports Medicine
    • Urology
      • Platt, McKay
  • Patient Education
    • Preventive Health Screening
    • Cancer Center
    • Cardiology
    • Dermatology
    • Ear, Nose & Throat
    • Endocrinology
    • Gastroenterology
    • Infectious Diseases
    • Internal Medicine
    • Nephrology/Chronic Kidney Disease
    • North Valley Orthopedics & Plastic Surgery
    • Orthopedic Specialty Center
    • Radiology/Imaging
    • Sports Medicine
    • Urology
  • Newsroom
    • Recent news
    • Top News
    • Physician News
  • Make a Payment
    • Pay online
  • Careers
Central Utah Clinic / About Us / Forms

About Us

  • History
  • Caring for our Community
  • Departments/Services
  • Office Locations
  • Forms
  • Outreach Clinics

    Home                                          

Forms

Cancer Center
Arbitration Letter
Arbitration Agreement
Diagnostic Evaluation
HIPAA Disclosure Authorization
Patient Information & History
Release of Health Information HIPAA

Cardiology

Arbitration Agreement
Arbitration Letter
Patient History
Release of Health Information HIPAA

Dermatology and Skin Cancer
Arbitration Agreement
Patient History
Patient Information & History

Ear, Nose & Throat

No Forms

Endocrinology

Arbitration Agreement
Patient Information & History

Gastroenterology

Arbitration Agreement
Patient History
Patient Information & History
Diagnostic Evaluation

Imaging/Radiology

No Forms

Infectious Diseases
Arbitration Agreement
Diagnostic Evaluation
Patient History & Information
Arbitration Letter
HIPAA Disclosure Authorization
Release of Health Information HIPAA

Internal Medicine

Arbitration Agreement
Patient History & Information

Nephrology/Chronic Kidney Disease

Arbitration Agreement
Patient History & Information
Arbitration Letter

North Valley Orthopedics & Plastic Surgery

Arbitration Agreement
Arbitration Letter
Orthopedic History Forms
Patient History & Information
Sensation Chart
Symptom Questionnaire

Orthopedic Specialty Center

Arbitration Agreement
Arbitration Letter
Orthopedic History Form
Patient History & Information
Sensation Chart
Sympton Questionnaire

Sports Medicine

No Forms

Urology

No Forms

Copyright © 2007 Central Utah Clinic, PC. All rights reserved.