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. 

To receive access to online history forms for the following facilities--patients MUST  pre-register first.

You may pre-register by either:

1. Calling the appropriate Pre-Registration Phone Center  OR
2. Submitting  a Online Pre-Registration Request form.

With either approach, the Patient Access Service Representative can send you an email with the link to the Online Forms homepage and instructions on how to complete the history forms online.

1. Pre-Registration Phone Centers:

Salt Lake ValleyArea: (801) 314-4395 or 1-888-269-8674; Mon-Fri, 8am - 7pm and Sat, 8am - 4pm

Utah Valley Area:  (801) 357- 7799;  8:30 am-9:30 pm

Dixie Area: (435) 688-4035; Monday through Friday; 8:00 am to 4:30 pm

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

2. Surgical Services Online Pre-Registration Request  Forms 

Salt Lake Valley Area:

• 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
• Riverton Hospital Surgical Services--Online Pre-Registration Form
• TOSH – Online Pre-Registration Form

Salt Lake Area Endoscopy

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

Utah Valley Area

• UVRMC Cardiac Cath Lab Services--Online Pre-Registration Form
• UVRMC Heart Surgery Services--Online Pre-Registration Form
• UVRMC Surgical Services--Online Pre-Registration Form
• Utah Valley Surgical Center--Online Pre-Registration Form
• American Fork Surgical Services--Online Pre-Registration Form
• Orem Community Hospital--Online Pre-Registration Form

Utah Valley Area Endoscopy

• Utah Valley Center for Digestive Health--Online Pre-Registration Form
• American Fork Hospital Endoscopy Sevices--Online Pre-Registration Form

Dixie Area (includes):

1. Dixe Regional Medical Center at 400 East
2. River Road Campus
3. Health & Performance Center

• 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.

• Cassia Regional Medical Center – Surgery Health History
• Logan Regional Hospital Surgical Center – Surgery Health History

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

• Surgical & Endoscopy Services