731 East 8600 South
Sandy, Utah 84094-6312
801-561-9987
800-530-1934
Email
|
FOR
CLIENTS
Biographies
SSCCC, the organization
Rob Pramann, Ph.D.
Angie Hendren, M.C.
Kara Jensen
J. Todd Northrop, M.C.
Pebble Pramann, M.S.
Mission
Services
Contact/Location
Notice
and Forms
*indicates
notice and forms required of new clients
(All non new client forms are explained in our Notice of
Privacy Practices which is available and listed below)
Access
Request Form
Accounting Request Form
Amendment Request Form
Authorization
for Release of Info. Form
Authorization Revocation Form
Confidential Communication Request
Form
*Consent
Form
*General
Information Form
*Insurance
Release Form
*Notice of Privacy
Practices
Privacy Complaint Fact Sheet
Privacy Complaint Form
Restriction Request Form
UBH
Wellness Assessment Forms, Adult
UBH
Wellness Assessment Forms,
Child/Adolescent
Calendar
Favorite
Links
|