University Orthopaedic Center

Build-A-Bone Registration Form

Please complete all requested information in the form below to submit your registration to the "Build A Bone" program.

BOLD - indicates a required field



(mm/dd/yyyy)






(000-000-0000)
(000-000-0000)

Are you currently, actively preventing Osteoporosis?

Do you have Osteopenia?

Do you have Osteoporosis?

Have you had a DEXA scan?

Would you like to be contacted in regard to having a future DEXA scan?

Class cost is $125. Cash or check preferred. Payment can be mailed prior to the class or paid at the first class.

Checks should be made out to:

Orthopaedic Center
590 Wakara Way
Salt Lake City, UT 84108

Classes will be held at the University Orthopaedic Center, 590 Wakara Way, in the Physical Therapy Clinic (2nd Level), 801-587-7005.