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Northern Utah's Premier Hematology and Oncology Provider

First Visit

Your first visit to Utah Hematology Oncology PC may come at a time filled with anxiety as you face a tremendous challenge. We would like to make your first and every visit as pleasant as possible.

 To help you prepare for your first visit, please either download/print, read and complete the forms listed below so that, upon your arrival, your focus can be on your visit with your provider. Please bring your government-issued photo ID; your current insurance card(s)—including pharmacy card, if different; the completed forms; and your initial copay (see your card or contact your insurance company for details).

·         Acknowledgement of Receipt of Privacy Practices (English)

·         Reconocimiento de Recibo de Prácticas de Privacidad (Español)

·         Authorization for Communication of Protected Health Information via Electronic Mail (English)

·         Autorización para la Comunicación de Información Protegida de Salud por Correo Electrónico (Español)

·         Authorization to Release Protected Health Information (English)

·         Authorization to Release Protected Health Information (Español)

·         Gray Medical History Form

·         Hansen Medical History Form

·         Johnson Medical History Form

·         Notice of Privacy Practices (English)

·         Notificación de prácticas de privacidad (Español)

·         Patient Financial Policy (English)

·         Política financiera del paciente (Español)

·         Patient Registration (English)

·         Registro del Paciente (Español)