Welcome to the InterMountain Medical Clinic Resources page. We know your time is valuable. To optimize your time with your provider it is helpful to have completed your intake forms. Below you’ll find digital handouts that you can easily reference at home or when you’re out and about. Download, print, then fill out and sign the documents below before your appointment.

Please review the forms for more information about the subject.

Patient Forms

Our Privacy Policy
Acknowledgement of Privacy Practices
Financial Policy
Notice of Nondiscrimination

New Clinic Patient Forms

New Patient Registration Form (all ages)
Adult Medical History Form
Child Medical History Form (less than 12 years old)

Other Forms

Patient Request for Health Information
Sliding Fee Discount Application
Sliding Fee Schedule
Medicare Health Risk Assessment

To access or obtain a copy of your patient records, please download, complete and return this form to:

Attn: Privacy Officer
Phone: (208) 238 -1000
1951 Bench Rd, Suite B
Pocatello, ID 83201
Fax:(208) 238 -0009

We may charge you a reasonable fee for copies of your records. We will require payment before providing the copies. Please contact us if you would like to obtain an estimate of the cost of the copies in advance.