Location   Patient Forms
 
Office Closure

We appreciate your business and look forward to serving you during the next regular office hours. 

Holiday Closures: 
Pioneer Day (7/23/10)
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Clinic Hours

Monday
9:00 AM to 6:00 PM
Tuesday
DK Hours after 6 pm; Community Clinic 9A-6P
Wednesday
9:00 AM to 6:00 PM
Thursday
DK Hours after 6 pm; Community Clinic 9A-6P
Friday
9:00 AM to 6:00 PM
Weekday Lunch Hour: 12N-1PM
Saturday
Medicare House Calls Only


Southwood
Medical Pavilion
880 East 9400 South
Suite 116
Sandy, Utah 84094
V: (801) 495-9303
F: (801) 495-9670

Map and Directions

 

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Scheduling
For the fastest service, 
Click Here to Schedule Online Now!

Or during office hours call
(801) 495-9303
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November 12, 2006
Preparing For Your First Visit

Forms

Our Patient Portal Where New Patients Can Now Register Online!

New patients who prefer to complete their new patient registration online can use the portal page on the menu to the left. Please allow pop-ups for the new registration form.

Traditional Paper Registration

For new patients who prefer paper forms, we ask that you take a few minutes to download and complete the appropriate forms before your first visit or your child's first visit. This will ensure you receive the best possible healthcare.

Please complete the following 5 forms:

  1. New Patient Registration 
  2. Consent form 
  3. Health History Questionnaire 
  4. Controlled Substance Agreement
  5. Release of Information Authorization

Please scroll to the bottom of this page for downloadable forms in Adobe PDF.  Download Adobe Reader.

Click on the pink text of the form's title to start your download.

Please request old records from your most recent health care providers prior to requesting a new patient appointment. No controlled substances (narcotics, sleeping pills, anxiety meds, ADHD meds) will be prescribed to new patients without old records on file at the Doctor Kara, PC Nurse Practitioner Clinic office. An additional $30 may be applied in cases of controlled substance prescriptions to cover the additional review of old records and record keeping that is required by state law for these prescriptions.
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How To Request an Appointment

New patients can self schedule an appointment using the self scheduling program. The "No Wait Guarantee" applies only to scheduled patients who have completed the new patient forms prior to their appointment. After reading the important information below, please self-schedule online or call 495-9303 to request an appointment.

Incomplete forms cannot be accepted and will delay your reservation.

Here is a link to the ATMs near our clinic office (click here for map).

Here is a list of banks, credit unions, and check cashing offices near the clinic office (click here to download PDF list). 

 
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Registration and Health History Forms
Health History Forms are important to ensure you get the best possible healthcare when you visit our office. New patients should complete the appropriate health history questionaire before their first visit at Doctor Kara, PC Nurse Practitioner Clinic. A registration form must also be completed by each new patient.
 TitleSize (Kb)Description
New Patient Registration70.57Please complete a New Patient Registration form before your first visit. This form also explains the billing policy of the clinic. ALL PATIENTS MUST COMPLETE THIS FORM.
Pediatric Health History35.87Health history questionnaire for children 12 years of age and younger
Adolescent Health History36.10Health history questionnaire for adolescents from 13 years old through 17 years old
Adult Health History36.56Health history questionnaire for adults 18 years old and older
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Consent and Controlled Substance Forms
The appropriate consent form, HIPPA form and policy forms must be completed and signed in order to receive treatment by Doctor Kara, PC Nurse Practitioner Clinic. Please have your forms completed and signed before the start of our visit.
 TitleSize (Kb)Description
Pediatric Consent Form16.84Consent form for children 17 years old and younger
Adult Consent Form16.67Consent form for adults 18 years old and older
Controlled Substance Client Agreement46.03Describes patient responsibilities regarding controlled substances. ALL PATIENTS MUST COMPLETE THIS FORM.
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Release of Information Forms
 TitleSize (Kb)Description
Release of Information Form45.30A release of information form that is used to request medical records from previous health care providers. OLD RECORDS MUST BE SUBMITTED TO THE CLINIC before receiving any controlled substance.
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Appointment Policy

We live in a crazy world and sometimes unforeseen circumstances prevent us from keeping commitments or appointments. Should something happen to you where you cannot make your appointment nor cancel your appointment more than 24 hours in advance, we will call you to make sure that nothing unfortunate has happened. We recognize that you are committed to the best-possible healthcare and that Doctor Kara, PC Nurse Practitioner Clinic patients do their best to keep appointments to help ensure the exceptional Nurse Practitioner Experience continues.

Most medical providers double and triple book their appointments because so many patients are late for their appointment, do not show, or cancel at the last minute.  Double and triple booking allows other healthcare providers to ensure that at least one patient will keep their appointment. Cancellation and no-show fees are common. Unfortunately, double and triple booking only punishes those who are on-time for their appointments as this creates the long waiting room experience we all know so well.

We do not double or triple book patients.  This means that you will not have to spend an hour in our waiting room because other patients have the same appointment you do.  It also means that keeping your appointment and being on-time is critical to your positive experience and no-wait guarantee.

The Doctor Kara, PC Nurse Practitioner Clinic No-Nonsense Appointment Policy

To review the Appointment Policy, please download the Registration Form on this page.  You will be asked to confirm your agreement to the terms and conditions when self-scheduling your appointment online. By asking for an appointment to be reserved for you on the office schedule book by phone, in-person, or via internet, you are agreeing to the terms and conditions of the policies by default. 
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