Medical Patient Forms

Whether you are a New Patient or returning to us, your basic information is very important. Please bring with you your Photo ID, Insurance Card (if any), Medical History and Prescription information (preferably current Rx bottles). To speed up the Check-In process, these forms may be printed, completed prior to your appointment and brought with you. If you have any questions about the forms, please call one of our offices at 208-356-4900.

Medical Patient Registration Form

Our Patient Registration form requires basic information that we are required to collect, please complete the entire form, sign and date.

Download Registration Packet – English Download Registration Packet – Spanish

Sliding Scale – Discount Application

To apply for our Sliding Scale discount, which is based on your household size and income, please complete the Sliding Scale Application. The information on this application also has to be verifiable and proof of income must be submitted to our facility within 3 days of your appointment, otherwise full fees will be charged.

Proof of income options

  • 2 months pay-stubs for all members of the household who are working
  • Previous year’s tax documents
  • Statements with income information
  • Social Security or Disability income statements
  • If you have no provable income, a letter from someone close to you that can verify your income and financial situation is acceptable. This letter must be signed and dated, and a phone number to reach this person is required.
  • If you have recently started a new job, the employer may either write a letter or you may have them complete our Income Verification form. This form must be signed and dated.

HIPAA Notice and Form

Your Privacy is very important to us! If you ever have a concern or question, please contact our facility ASAP. The HIPAA/Privacy Notice is a document for your information, please only bring a signed and dated copy of the Acknowledgement form.

Notice of Privacy Practices – English Notice of Privacy Practices – Spanish

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