Download Our Patient Forms or Register Online
Patient Registration
Our Patient Forms
In order to be evaluated for the Lap Band procedure, Dr. Hansen needs the following form completed. You can reduce the amount of time you spend in our office by downloading and completing the Health History form or Registering Online through our Patient Portal before your first visit. This information will be securely stored in your electronic medical record.
You may need to use Adobe Acrobat Reader to view the Health History form. After you've downloaded it, you can fill it out electronically by clicking each of the fields and typing in your information.
Once you've completed the form, you can email it to us at moc.nesnahdrd%40ofni, print it and fax it to our office at (801) 660-2492.
In order to be evaluated for the Lap Band procedure or weight loss injections
Payment
Payment is due at the time of service. Your co-pay will be requested during your visit for insurance plans. We can bill your insurance with the understanding that there will likely be additional payments due for procedures depending on your plan.
No insurance? We're happy to see you, but we request a $200.00 visit fee for a consultation. For elective surgeries, the expected fee will be discussed with you, and payment is due before your surgery can be performed (unless other arrangements have been made).
Dr. Hansen accepts VISA and Mastercard. Discounts are given for cash payments.
Facilities
Many smaller procedures can be performed in the office such as Lipomas, Cysts, Skin lesions when appropriate, with considerable savings compared to using the operating room at another facility. Dr. Hansen will decide with you if this is an option.
For all other facilities, we will schedule your procedure for another day. The facilities where Dr. Hansen operates and admits patients are:
Each of these facilities requires its own registration process. Once a procedure has been agreed upon with you and Dr. Hansen, our office will initiate the scheduling with the facility. Click on the button below to visit the page with the information they'll request from you.