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Request an AppointmentLayton Clinic

Request an AppointmentLayton Clinic 2026

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The document is a comprehensive patient intake and policy form for Jasmer Health, LLC, located in Layton, Utah. It includes sections for personal information, insurance details, medical history, and consent for treatment. The document outlines appointment policies, payment procedures, and collection practices to ensure patients understand their responsibilities regarding mental health services. Additionally, it emphasizes the importance of completing forms prior to appointments and provides guidelines for follow-up visits and communication with the clinic.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Patient Information' section. Enter your full name, social security number, address, and contact details. Ensure all fields are completed accurately.
Next, provide your insurance information under 'Primary Insurance'. Include the responsible person's details and insurance company name along with the ID number.
If applicable, complete the 'Additional Insurance' section by indicating whether you have secondary insurance and providing relevant details.
In the 'Assignment and Release' section, read through the statements carefully. Sign and date where indicated to authorize treatment and payment assignments.
Complete any additional questionnaires regarding medical history and mood disorders as required. This information is crucial for your healthcare provider.
Review all entries for accuracy before submitting. Save your completed form within our platform for easy access during your appointment.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (66 Votes)

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Who are the doctors at Tufts Medical Center?

Access to top specialists Michael Paasche-Orlow, MD, MPH. Internal Medicine, Primary Care. Jana Naef, MD. Internal Medicine, Primary Care. Dhrusti Patel, MD. Internal Medicine, Primary Care. Holly Wilson, PA. Internal Medicine. Jenny Hong Gao, MD, PhD. Kerrilyn Murphy, MD. Joan Kross, MD, MPH. Irakli Todua, MD.

Who are the doctors at Layton Clinic?

Schedule with a provider Grant E. Child, LCMHC. Counseling. New patient appointments next week. 4.9. Ryan R. Horning, PA. Joey A. Hanson, MD. Family Medicine. 4.9. Todd L Shelby, MD. Family Medicine. 4.9. Heather N McConney, PA. Family Medicine. 4.9. Jacob C. Saunders, MD. 4.7. Matthew S. Spencer, MD. 4.9. Marc L. Johnson, MD.

When did Layton Hospital open?

Intermountain Health Layton Hospital, located in Layton, Utah, opened in October 2018. This not-for-profit, full-service community hospital offers advanced medical care, including emergency services, surgical procedures, and specialized treatments.

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