Serving Salt Lake City since 1999

Patient Forms

Fax Us



To best serve our customers, we are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child’s first appointment. You can also fax them to us at 801-506-0188 Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child’s first visit.


New Patient Forms

Other Forms

  • Appointment of Personal Representative [PDF] [Online]
  • Vanderbilt ADHD Assessment Scale – Teacher Informant [PDF] [Online Form]
  • Vanderbilt ADHD Assessment Scale – Parent Informant [PDF] [Online Form]


   In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.

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