801-408-5700 Fax: 801-408-5704

PATIENT INFORMATION

All you need to know about Rocky Mountain MS Clinic and your visit

 

Your Initial Visit

Please review all the information below and then follow the link to our New Patient Forms Page.

To help us serve you better, please arrive 20 minutes early with the following items:

  • Actual film copies or discs and reports from any MRI
  • Office notes from your previous doctors, for example, other neurologist, cardiologist, family practitioner, etc
  • All test results, including but not limited to lab, x-ray, CT, EEG, VEP, EMG/NCV, echocardiogram, lumbar puncture, etc
  • List of all medications, including over-the-counter medicines, and the dosage being taken
  • Insurance cards and copay

Before your appointment, please confirm our providers are covered by your insurance.


If your insurance requires a referral, YOU must obtain it from your referring physician. If this is not obtained, your insurance will not pay, and you will be responsible for the entire bill.


If you arrive more than 10 minutes late or do not bring ALL of the above mentioned items you will be asked to reschedule.


We request that patients give 24-hour notice if it is necessary to cancel or reschedule your appointment. Please call our clinic at 801-408-5700 at least 24 hours in advance for a new appointment time.

New Patient Forms

Download and complete the forms prior to your first visit

Please print the forms applicable to your visit type and complete them prior to you first appointment.  It is not required to bring back the copy of the Privacy Policy, but the Privacy Policy Acknowledgement is required.

General Neurology Packet

MS or Possible MS Packet

Headache Packet

Noticy of Privacy Practice

Release of Health Information

To obtain medical records, please complete this form and return to us by fax (801-408-5704) or mail (370 E 9th Ave Ste 106 SLC, UT 84103). Thank you!

Infusion Referral Form

Outside physicians: Please complete/fax the referral order form for your patient to infuse with us. Thank you!