Patient Forms

It is vital that you complete the following forms and return them via email or in person to our office at least one week prior to your first appointment. Failure to do so may result in the cancellation of your appointment. 

****Please scan or take pictures of both sides of your insurance card and email the scans/images to info@premierpcc.com.****

We HIGHLY recommend using Adobe Acrobat Reader to complete the following forms.

Download a free copy of  Adobe Acrobat Reader

Other PDF software may be used, but some functionality of the forms may be altered and you will need to manually email the forms back to our office.

New Patient Forms-Adult

New Patient Forms-Child (under 18 yrs)

Health Information Release Forms

If you have any questions about the forms or how to submit them, please call our office (435-216-9290) and we will be glad to help you.