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Sending information to UDHS (Please fill out the form for the location you are recieving treatment at using the following instructions):

1. Click the link to the form that you would like to submit
2. Fill in information as completely as possible (**note signatures and SSN information is excluded for electronic submission, all electronic submissions will need to be signed and have your SSN entered the next time you visit)
3. Click the Submit by email button at the bottom of the form
4. An email with an attachment should open, click send
5. If you would like a copy of the form or were unable to send the email, click the print button

Salk 3189 location

• Patient Registration

Oral Surgery

• Patient Registration

Montefiore

• Patient Registration