We request that you obtain a referral from your physician before filling out the form below. Once you have obtained your referral and the form has been completed we will call you as soon as possible to schedule your appointment. Please expect a response during office hours Monday through Friday. If you do not receive a response during office hours within 24 hours or have any questions please call 801-387-7880.

This appointment request form should not be used for urgent or emergency care. If you are experiencing life-threatening symptoms dial 911 or go to the nearest emergency room.


This form should not be used for urgent care matters or potentially life threatening conditions. In those situations, please contact 911 or head to the nearest Instacare or emergency room.