Forms

If you are coming to our office for the first time, why not get a headstart so that you can have more time in therapy and spend less time filling out forms? Simply download these files, fill them out, print them and bring them with you to your appointment.  You may also email them to admin@summitcom.org. (Note: If you fill them out electronically, please be aware that they will still need to be hand-signed. Simply let the receptionist know that you sent them in via email and need to sign them. Thank you!)

Notice of Patient Rights and Responsibilities (en español)

Authorization for Treatment and Payment (en español)

Social Intake Questionnaire

Optional:

Client Request for Personal Health Information (HIPPA)

Financial Assistance Application

 

A couple

Our Therapists

Karen MalmAndrew AlderKayla AtkinBrian CherryMaxwell DahmenMeghan ElkinsKim EnglandMonica FlorezLeah HuhnkeDouglas HustonKendyl LeasureJacky McAlisterClare RakowskiRachel RamosRebecca RudaMichelle SandersDerek SmithTamatha SmithKim SolomonKristina TalbertMarilee TuifuaNicole WhartonPaul WoolfAndrea Young

Contact Us

Main Office: 5689 S. Redwood Road  Suite 27
Taylorsville, UT 84123
801.266.2485
866.644.9206
admin@summitcom.org
   Orem: 359 E. 1200 S.
Orem, UT 84058
   Park City: 1910 Prospector Ave Suite 201A
Park City, UT 84060
   Heber: 150 N. Main Street Suite 204 #6
Heber, UT 84032
   Layton: Arrowhead Stables
897 S. Angel Street
Layton, UT 84041
   Murray: 4991 S. Commerce Drive
Murray, UT 84107
801.266.1308
801.266.1308

Summit Community Counseling, Marriage, Family, Child, Individual Counselors, Taylorsville, UT