Intermountain HealthcareOnline ToolsOnline Pre-Registration and Health History Forms

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.

TWO WAYS TO PRE-REGISTER:

  1. Calling the appropriate Pre-Registration Phone Center
  2. Submitting  the appropriate 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:

Logan Regional Hospital: 1-888-269-8674; Mon-Fri, 8 am - 7pm

McKay-Dee Hospital Center: (801) 387-7690; Monday through Friday, 8 am to 7 pm 

Salt Lake Valley Area: (801) 442-8600 or 1-888-269-8674; Mon-Fri, 8 am - 7pm

Utah Valley Area:  (801) 357- 7799;  Monday through Friday 8 am-9 pm

Dixie Area: (435) 688-4035; Monday through Friday; 8:00 am to 5 pm

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

2. Surgical Services Online Pre-Registration Request  Forms 

Northern Utah (McKay and Logan):

Northern Utah Endoscopy:

Salt Lake Valley Area:

Salt Lake Area Endoscopy

Utah Valley Area

Utah Valley Area Endoscopy

Dixie Area (includes):

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

If you have any questions or encounter any difficulties with the online forms, please contact our Online Services support by either:

1. Calling  801-442-5502 (Salt Lake area) or 800-442-5502 Monday through Friday, from 7:00 a.m. to 8:00 p.m. and Saturdays, from 7:00 a.m. to 3:00 p.m.   OR
2. Email mypersinfo@imail.org to contact our technical staff. Emails are responded to weekdays between 8 a.m. and 5 p.m.

 

 

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

 
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