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:
- Calling the appropriate Pre-Registration Phone Center OR
- 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:
Salt Lake Area Endoscopy
Utah Valley Area
Utah Valley Area Endoscopy
Dixie Area (includes):
- Dixe Regional Medical Center at 400 East
- River Road Campus
- Health & Performance Center
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.
For additional information and contact numbers for Intermountain's surgical and endoscopy services: