There are several forms to complete. Please do not hesitate to ask Dr. King to mail copies of the forms to you for your convenience. If you prefer, you are welcome to print the forms, complete them, and mail them to Dr. King at PO Box 102, Willard, UT 84340. When the forms are received, Dr. King will call to schedule. She is currently able to see new patients in less than two weeks.
Right click the icon below the title of the form you wish to open, then click on Open Link.
Patient Information
Insurance Information
Informed Consent
Financial Agreement
Email Use
Procedures with Young Children
Child History
HIPAA Notice (This is to be read only. You do not need to print this unless you want to keep a copy for your records.)
HIPAA form to request alternate handling of communications to you, to be completed only if you do not wish to receive mail from Dr. King at the address you list on your Patient Information form, i.e., if you would like mail to be sent to an alternate address for confidentiality reasons.
