Resources

Resources and Links

Dr. Nielsen Resources

Welcome to the InterMountain Medical Clinic Resources page.  We know your time is valuable.  To optimize your time with your provider it is helpful to have completed your intake forms. Below you’ll find digital handouts that you can easily reference at home or when you’re out and about.  Download, print, then fill out and sign the documents below before your appointment.

Patient Forms

Click on the links below to access forms. Print the forms and fill them out before coming to our office.

Our Privacy Policy

Acknowledgement of Privacy Practices

Financial Policy

Notice of Nondiscrimination


 

New Clinic Patient Forms

New Patient Registration Form (all ages)

Adult Medical History Form

Child Medical History Form (less than 12 years old)


 

Osteoporosis Forms

DXA Information

First DXA Scan Questionaire

Repeat DXA Scan Questionaire

DXA Wellness Screening Authorization

 


 

Other Forms

Patient Request for Health Information

Treadmill Stress Test Information


To View these Forms and Documents you will need to have the Adobe Reader Application Installed.
You can install and download it from here.
get_adobe_reader

To access or obtain a copy of your patient records, please download, complete and return this form to:

Attn: Privacy Officer
Phone: (208) 238 -1000
1951 Bench Rd, Suite B
Pocatello, ID 83201
Fax:(208) 238 -0009

We may charge you a reasonable fee for copies of your records. We will require payment before providing the copies. Please contact us if you would like to obtain an estimate of the cost of the copies in advance.

 


Downloads