Patient Forms

Access patient forms below

Records Release
Form

Healthy Connections
Enrollment

Healthy Connections Enrollment (Spanish)

Special Circumstances Change Request Form

Special Circumstances Change Request Form (Spanish)

CALL 911 IF YOU THINK YOUR CHILD IS EXPERIENCING A LIFE-THREATENING EMERGENCY.

IF YOU THINK SOMEONE IS POISONED, CALL THE POISON CENTER AT 1-800-222-1222.

Idaho Falls

Urgent Care

3320 So. 25th East
Idaho Falls, Idaho 83404

Phone: (208) 656-1500
Fax: (208) 656-1502

Chubbuck

Urgent Care

190 Bullock St. Chubbuck, Idaho 83202 Phone: (208) 992-5109
Fax: (208) 237-9029

Rexburg

Urgent Care

1218 Bond Ave.
Rexburg, Idaho 83440

Phone: (208) 747-0339
Fax: (208) 900-4301

Rexburg

Primary Care

1218 Bond Ave.
Rexburg, Idaho 83440

Phone: (208) 701-0277

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