Help us serve you more efficiently by downloading and filling out the various patient forms available on our website. This procedure allows you to review and fill out the forms in the comfort of your home and where you are likely to have the needed information at your disposal. Our goal is to make registering more convenient and save time for both you and our clerical staff.  The forms are formatted in Adobe PDF and are of two types: (1) Static Form that you download and print from your computer, which you then fill out by hand and mail to us through the post office, and (2) Fill-in the blanks Form, using your keyboard to fill out the form and submit via email.
Note:  You should already have the Adobe Reader installed on your computer.  However, if you need a new version of the program, click on the logo to the right.
(1) Static Forms (pdf) - Fill in by hand & mail
  • Registration and Patient Medical History Form
  •   This form consists of two sections namely, the family & patient information page and the patient medical history page.

  • Consent and Acknowledgment Receipt
  • consists of a two sections: (1) a consent agreement that authorizes the clinic to release the patient medical information to a designated relative(s) or personal contact, and (2) an acknowledgment receipt showing that the patient has received a Notice of Privacy Practices document.

  • National Health Service Corps
  • As a member, our policy at Beaver, Milford & Parowan Medical Clinics is to provide essential services regardless of the patient's ability to pay.

    Click on the underlined links and download the (pdf) files. You can then print them out immediately or save them to your computer for printing later. Fill them out with a pen and mail them to the clinic that you intend to register with or bring them with you on your next visit.
    (2) Fill-in the blanks (pdf) - Type and submit
  • Registration and Patient Medical History Form
  •  This form consists of two sections namely, the family & patient information page and the patient medical history page.

  • Consent and Acknowledgment Receipt
  • consists of a two sections: (1) a consent agreement that authorizes the clinic to release the patient medical information to a designated relative(s) or personal contact, and (2) an acknowledgment receipt showing that the patient has received a Notice of Privacy Practices document.

    Click on the underlined links and download the (pdf) files. Then, fill in the blanks within the forms. Prior to submitting the forms using the Submit Via Email button, please print them out to retain a record.  Note: If you plan to submit the form electronically, you first need to call and obtain a PIC (Personal Identification Code) to use along side your typed in signature. Alternatively, you can print out the forms and bring them with you on your first appointment.

    Copyright 2016 Beaver Medical Clinics 1059 North 100 West
    Beaver, Utah 84713
    Tele:(435) 438-7280     Fax:(435) 438-7210
    Email: info@beaverclinic.net
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