Intake & Insurance Form

Get in Touch

Contact our Admissions Director, Bridget, at Wildflower Mountain Ranch

(801) 835-9359

Parents First & Last Name

Daughters First & Last Name

Daughters Date of Birth

Phone Number

Address

Comments

Will You Be Using Insurance?

Yes

If Not, Please Give Us More Information

If So, What Insurance?

Upload Insurance Card

Schedule an appointment

May 2026

Week starting Sunday, May 17

Time zone: Coordinated Universal Time (UTC)Phone call

Tuesday, May 19

10:00 AM - 11:00 AM

11:00 AM - 12:00 PM

12:00 PM - 1:00 PM

1:00 PM - 2:00 PM