Notice and Forms


	Forms, Notices, and Brochures 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 Client Brochure (Word version) single sided (PDF vers) 2 sided (Publisher vers) 2 Confidential Communication Request Form Consent Form General Information Form Identity Verification Form Explained 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
731 East 8600 South Sandy, Utah 84094-6312 801-561-9987 800-530-1934 Email
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