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Patient Registration

For more convenience, our patients can download and print the following forms. Filling out and bringing these forms with you to your initial visit will make the check-in process easier and faster.

Patient Registration Forms

New Patient Registration Form

Disclosure Authorization Form

Arbitration Agreement

Summary/Explanation of Arbitration Agreement

Notice of Privacy Practices

All downloads are in PDF format. You will need to have Adobe® Reader® installed on your computer in order to view and/or print these files.

Our Locations

Cedar City

Zion Eye Institute - Cedar City
1811 W Royal Hunte Dr Ste 2
Cedar City, UT 84720

St. George

Zion Eye Institute:
1791 East 280 North
St. George, UT 84790

Santa Clara

Zion Eye Institute – Eye Care Santa Clara, Utah
1100 Canyon View Dr. Unit G
Santa Clara, UT 84765

Mesquite

Zion Eye Institute – Eye Care Mesquite Nevada
1301 Bertha Howe Ave. Suite 11
Mesquite, NV 89027

Contact Us

To contact Zion Eye Institute, please call us toll-free at (877) 841-2020

Quick Links

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This Practice does not sell, rent or lease its customer lists to third parties. This Practice may share data with trusted partners to help us perform statistical analysis, send you email or postal mail, provide customer support, or arrange for deliveries. All such third parties are prohibited from using your personal information except to provide these services and they are required to maintain the confidentiality of your information.

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