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    • Spencer Barney, M.D.
    • Erica Faircloth, M.D.
    • Christian D. Froerer, M.D.
    • Jonathan B. Gibson, M.D.
    • Caitlin Indart, M.D.
    • Daniel F. Kaelberer, M.D.
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  • (385) 758-1920
  • (385) 758-1921
  • Home
  • Services
    • Obstetrics
    • Gynecology
    • Surgery
    • Pro-Nox
  • Patient Resources
    • FAQs
    • New Patient Forms
    • Insurance and Billing
  • Providers
    • Spencer Barney, M.D.
    • Erica Faircloth, M.D.
    • Christian D. Froerer, M.D.
    • Jonathan B. Gibson, M.D.
    • Caitlin Indart, M.D.
    • Daniel F. Kaelberer, M.D.
    • Spencer Pierson, M.D.
    • Steven M. Thackeray, M.D.
  • Blog
  • About Us
  • Contact Us
  • Pay Online
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  • (385) 758-1920
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New Patient Forms

Download and complete the following forms before your first visit to save time at check-in.

  • New Patient Intake Form
  • Medical History Form
  • Insurance Information Form
  • Consent for Treatment and Privacy Practices
New Patient Intake Form
Medical History Form
Financial Policy
Telehealth Consent
Insurance Information Form
Consent for Treatment & Privacy Practices
Our practice is dedicated to providing exceptional care to women from adolescence through menopause, with a special emphasis on pregnancy and reproductive care. We offer a full range of routine and preventative health services, are experienced in all aspects of pregnancy care, and perform gynecological surgeries including many minimally invasive surgeries.

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  • 291 West 5400 South, Murray, Utah 84107
  • Call: (385) 758-1920
  • Fax: (385) 758-1921

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