Resources

RESOURCES AND LINKS

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.

Click on the links below to access forms. Print the forms and fill them out before coming to our office.

Patient Forms

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

New Clinic Patient Forms

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

Osteoporosis Forms

DEXA Information
First DEXA Scan Questionaire
Repeat DEXA Scan Questionaire
DEXA Wellness Screening Authorization

Other Forms

Patient Request for Health Information
Treadmill Stress Test Information
Sliding Fee Discount Application
Sliding Fee Schedule

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.