Online Pre-Registration and Health History Forms

Several Intermountain surgical and endoscopy services provide Online Health History forms for surgery or endoscopy procedures, which can be completed and submitted online in a secure electronic format. 

Remember-- some hospitals provide surgical and procedure services at more than one location. To be sure your history form is sent to the right facility, please confirm exactly where your surgery or procedure will be performed, by contacting your surgeon's or doctor's office.

Salt Lake Area Surgical Services Online Pre-Registration Forms

To receive access to online history forms--patients MUST  pre-register first.

You may pre-register by:

1. Filling out a pre-registration form online (see links below) OR
2. Calling the pre-registration center at (801) 314-4395 or 1-888-269-8674;  Mon-Fri, 8am - 7pm and Sat, 8am - 4pm.

If you would like to fill out your health history forms online, the Patient Access Service Representative can send you an email with the link to the Online Forms site.

Once you submit your health and medication history forms online, the forms will automatically be sent to the surigical service where your procedure is to be done.

• Alta View Surgical Center – Online Pre-Registration form
• Avenues Surgical Center – Online Pre-Registration Form
• Intermountain Medical Center Cath Lab – Online Pre-Registration Form
• Intermountain Medical Center Same Day Surgery – Online Pre-Registration Form
• Intermountain Surgical Center – Online Pre-Registration Form
• LDS Hospital Surgical Services – Online Pre-Registration Form
• TOSH – Online Pre-Registration Form

Salt Lake Area Endoscopy Online Pre-Registration Forms

• Alta View Hospital Endoscopy – Online Pre-Registration Form
• Intermountain Medical Center Endoscopy – Online Pre-Registration Form
• LDS Hospital Endoscopy – Online Pre-Registration Form

Dixie Area Surgical Services Online Pre-Registration Forms

To receive access to online history forms--patients MUST  pre-register first.

Patients should pre-register for procedures or surgery to be performed at any one of the following locations:

• Dixe Regional Medical Center at 400 East
• River Road Campus
• Health & Performance Center

You may pre-register by:

1. Filling out a pre-registration form online (see link below)  OR
2. Calling the pre-registration center at  (435) 688-4035; Monday through Friday; 8:00 am to 4:30 pm.

If you would like to fill out your health history forms online, the  Patient Access Service Representative can send you an email with the link to the Online Forms site.

Once you submit your health and medication history forms online, the forms will automatically be sent to the surigical service where your procedure is to be done.

• Dixie Surgical Services--Online Pre-Registration Form

Other Surgery Online Health History Forms

Pre-Registration is currently by phone only for the following facilities.. Direct links to these facility's online histories are provided below.

• American Fork Hospital – Surgery Health History
• Cassia Regional Medical Center – Surgery Health History
• Logan Regional Hospital Surgical Center – Surgery Health History
• Orem Community Hospital Surgical Services – Surgery Health History
• UVRMC Surgical Center – Surgery Health History
• UVRMC Surgical Services – Surgery Health History
• UVRMC Heart Surgery Services – Surgery Health History
• UVRMC Cardiac Cath Lab – Surgery Health History
• Valley View Medical Center Surgical Services – Surgery Health History

Other Endoscopy Online Health History Forms

• Utah Valley Center for Digestive Health – Health History

For additional  information and contact numbers for Intermountain's surgical and endoscopy services:

• Surgical & Endoscopy Services