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Patient Forms

Download and print New Patient forms as well as Medical Record Release etc.
View Canyon Surgical Clinic Patient Forms.

Appointments

Medical Records Release and Confidentiality

To maintain strict confidentiality of our patients, we require written permission from the patient before any records can be released to another physician, insurance company or any other person.

Fill out our medical release form and fax or mail it to the appropriate location. Once this form is received, copies will be sent accordingly.

Please read and be familiar with our Privacy Policy Statements.

Insurance and Disability Forms

Please bring any forms that need to be filled out to our office. There is a $15 charge for "out of work/disability" forms to be completed, which will be collected when the forms are presented to our office.

In Case of Emergency

You may reach Canyon Surgical Clinic by calling (435)723-0329 during Office Hours. If you or your family feels the situation is life-threatening or demands immediate attention, dial 911 or go directly to the emergency room nearest you.

Office Visits

• Current insurance cards.
• A list of all medications you currently take. Include medication name, dosage, and name of the prescribing physician.
• Co-payment as required by insurance.

• Payment Information

• Billing Information

• Office Hours & Emergencies

• Health Insurance Plans

• Patient Forms