For an appointment
Call 208.354.9579
Call 208.354.9579
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New Patient Forms
Welcome to Vital Health! Thank you for making an appointment. I look forward to meeting you. Please print and fill out the following forms (adult or pediatric health profile, new patient info form).
It is very important that Dr. Wiegand receives a copy of your health profile prior to your first visit. You can:
- Fax it to 208.354.9578
- Mail it to PO Box 579, Driggs, ID 83422
- Drop it off at the office at 189 N Main St, Suite 114 in Driggs
If unable to submit on time, please bring your filled out forms to your first appointment, along with copies of any recent lab reports and bottles of supplements you are currently taking.
Adults/Teenagers - Please print and fill out both forms and read the privacy notice below.
New Patient Information Form.pdf
Adult Health Profile Form.pdf
Children - Parents, please print and fill out both forms and read the privacy notice below.
NOTE: If patient is of the age to fill out their own form, please use the adult form above.
New Patient Information Form.pdf
Pediatric Health Profile Form.pdf
Notice of Privacy Practices
Please read this notice prior to signing the receipt of privacy policy section on the New Patient Information Form.
Notice of Privacy Practices.pdf