Schedule Your Appointment

Contact Details

601 UT-198
Salem, UT 84653

We are excited to see you! In order to best serve you, we have created this form to facilitate scheduling an appointment that best fits your schedule. Please complete all of the following questions. We will check our calendar availability and call you to coordinate and confirm a convenient time for you.
Name*
First Last
Email*
Phone*
Are You a New Patient?*
- Yes
- No
How Did You Hear About Us?*
Are You Scheduling for Yourself or Your Child?*
What are your primary concerns?*
What are your primary concerns for your child?*
Other*
What time of day do you prefer (Mornings or Afternoons)?*
Preferred Day of the Week?
- Select All
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Would You Briefly Describe Your Situation? (Optional)
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