Sunday, September 05 2010
7478 Campus View Dr. Suite 100 West Jordan, UT 84084 • 801-280-7774
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          Jordan Landing Clinic

Online Patient Forms

Our Patient forms are available as PDF documents. You will need the Adobe Acrobat Reader to view the forms.  

Family Clinic

  1. Patient History and Information
  2. Authorization to Release Medical Record Information
  3. Arbitration Agreement
  4. Notice of Privacy Practices Acknowledgement
  5. Notice of Privacy Practices
  6. Medicare/Medicaid Waiver
  7. Permission to transmit Lab Results via Email
  8. Permission to send Newsletter through Email
 
 
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Laser Aesthetics

  1. Jordan Landing Laser Aesthetics Client Information
  2. Jordan Landing Laser Aesthetics Patient Information
  3. Permission to send Newsletter through Email
  4. Arbitration Agreement
   

 

 
 

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