Special Care for Mother and Baby

1140 E. 3900 S., Suite 390
Salt Lake City, UT 84124
Phone: 801-743-4700
Fax: 801-743-4705

Patient Registration Forms and Privacy Notices

Registration & Medical History

Patient Registration Form

Family History and Genetic Screening Form

Patient Consent for Services

Medical Records Release Authorization

Permission to Release Private Health Information

Financial Policy Acknowledgement

Privacy Notices

This privacy notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Notice of Privacy Practices

Aviso Sobre Las Practicas De Privacidad

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