Our Providers Mountain News Patient Resources Therapist Resources Contact BILL PAY Patient Resources Included below are patient demographic forms used to tailor your individual care. Feel free to print these documents and complete them prior to your appointment. We also ask that patients come prepared with a valid form of ID, as well as their current insurance information. Should you have questions about any of these forms, please feel free to speak with an Administrative Assistant at your appointment and they’ll be glad to assist you. Demographics Form All Mountain Orthopaedics patients should complete Intake Form Murray, Edwards, Huish, Hickman, Tyson, and Wooten patients should complete Intake Form Johnston patients should complete Achilles Repair Diet and Inflammatory ©2016 Mountain Orthopaedics LLC

Our Providers Mountain News Patient Resources Therapist Resources Contact BILL PAY CONTACT US Phone 801-295-7200 Fax 801-295-4930 After Hours 801-299-7617 Hours M-F 8:00am-5:00pm Keyboard shortcuts Map Data Terms of Use Report a map error This page can't load Google Maps correctly. Do you own this website? OK 1551 Renaissance Towne Dr. Suite 400 Bountiful, UT 84010 Directions Keyboard shortcuts Map data ©2021 Terms of Use Report a map error This page can't load Google Maps correctly. Do you own this website? OK 201 W. Layton Parkway, Suite 400 Layton, UT 84041 Directions Contact Office Manager Please use the form below to ask any questions you may have or express any concerns and we will respond to you shortly. Alternatively you can send an email to asimmons@mountainortho.com Please do not use this form for the following: • Appointment requests • Medical information or questions (HIPAA Law Prohibits) Name: Email: Subject: Message: ©2016 Mountain Orthopaedics LLC