Submitted by ahs-admin on Fri, 12/29/2017 - 12:36 Request an Appointment First Name * Last Name * Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Phone Number * Email * Date of Birth MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Year Gender * - Select -MaleFemale Provider * - Select -AnyMara A Additon, MDDouglas K Andersen, DOGabriela C Anghel, MDGustin R Blad, NPBenjamin Blair, MDS Jeff Bray, DPMMartha I Buitrago, MDRobert L Cach, MDBenjamin F Call, MDHannah E Caulfield, MDJordan C Chapman, NPKelli D Christensen, MDJacqueline R Cutler, PAJorge E De Amorim Filho, MDJacob DeLaRosa, MDKrista Diekemper, Marc V Farnworth, MDLuis M Fernandez, MDMichael L Francisco, MDKatie J Fritz, MDJonathan D Godfrey, MDDavid M Gonzalez, MDMatthew M Gregson, PAFernando Grigera, MDMakenzi M Gwinn, AuDWade Harris, MDAlfonso Hernandez, PAJessica R Horst, NPKolby V Johnson, MDShad C Johnson, PAJimmy L Jones, NPPeter J Jones, MDAnthony E Joseph, MDSteven M Krawtz, MDCody L Martin, MDDavid M McDonald, PAAshley McNamara, PADrew W McRoberts, MDNatalie M Miller, PAJonathan T. Morgan, DOAustin C Myers, MDKevin P O'Halloran, MDJ. Lynn Otto, MDKim N Poludnianyk, DOJared M Price, DOTyler G Robertson, DOJennifer L Robinson, PADebra L Rodriguez, CNS Yolanda Rodriguez-Valdivia, MDAlexa E Roth, MDBrandon C Scott, DOKeith A Somma, MDRoberta Turner, FNP-BCJulio C Vasquez, MDS. Theresa Walbridge, PARichard A Wathne, MDSteven J Webster, DOJacob W Wendling, DOChristopher D Williamson, PAJared K Wilson, PAMorgan G Yost, DO Have you been seen by a Portneuf Medical Group provider in the last three years? * - Select -YesNo Service Requested * - Select -BariatricsCancer CenterColon ScreeningDepartment of SurgeryDiabetes EducationEar, Nose, Throat and AudiologyGastroenterologyInfectious DiseaseIV TherapyLung + SleepMammographyMedical Imaging and RadiologyNephrology & DialysisNeuroscience and RehabilitationOccupational MedicineOrthopedicsPrimary CareRheumatologyTherapy ServicesUrgent CareUrologyWound Care and Hyperbaric Medicine Appointment Date Requested * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202420252026 Year Message|Additional Comments Submit