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 by calling the appropriate Pre-Registration Phone Center listed below.

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.

Pre-Registration Phone Centers:

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

  • Logan Regional Surgical Services
  • Logan Regional Endoscopy Services

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

  • McKay-Dee Hospital Surgical Services
  • McKay-Dee Surgical Center

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

  • Alta View Surgical Center
  • Alta View Endoscopy
  • Avenues Surgical Center
  • Intermountain Medical Center Cath Lab
  • Intermountain Medical Center Endoscopy
  • Intermountain Medical Center Same Day Surgery
  • Intermountain Surgical Center
  • LDS Hospital Surgical Services
  • LDS Hospital Endoscopy
  • Primary Children's Medical Center Surgical Services
  • PCMC Riverton Outpatient Surgical Services
  • Riverton Hospital Surgical Services
  • TOSH

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

  • Park City Surgical Services
  • UVRMC Cardiac Cath Lab
  • UVRMC Heart Surgery Services
  • UVRMC Surgical Services
  • Utah Valley Surgical Center
  • Utah Valley Center for Digestive Health
  • American Fork Surgical Services
  • American Fork Endoscopy
  • Orem Community Hospital

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

  • Dixie Regional Medical Center Surgical Services (400 East)
  • River Road Campus
  • Health & Performance Center

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.

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 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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