Utah Code Title 53. Public Safety Code § 53-5c-302. Assistance from a health care provider--Restricted list

(a) an individual who is directing a health care provider to electronically deliver the individual's inclusion request and require, at a minimum, the following information:

(b) a health care provider who is delivering an individual's inclusion request and require, at a minimum, the following information for the health care provider:

(3)(a) An individual who is directing a health care provider to electronically deliver the individual's request to be included on a restricted list shall, in the presence of the health care provider, complete the forms described in Section 53-5c-301 and Subsection (2)(a).

(b) The health care provider:

(4)(a) The form described in Subsection (2)(a) shall have the following language prominently displayed before the signature:

“ACKNOWLEDGMENT

By presenting this completed form to my health care provider, I understand that I am requesting that my health care provider present my name to the Bureau of Criminal Identification to be placed on a restricted list that restricts my ability to purchase or possess firearms.”

(b) The form described in Subsection (2)(b) shall have the following language prominently displayed before the signature:

“ACKNOWLEDGMENT

By presenting this completed form to the Bureau of Criminal Identification, I understand that I am acknowledging that I have verified the identity of [name of individual seeking inclusion on a restricted list] and have witnessed [name of individual] sign the form requesting that [name of individual] be placed on a restricted list that restricts [name of individual]'s ability to purchase or possess firearms. I affirm that [name of individual] is currently my patient, and I am a licensed health care provider acting within the scope of my license, certification, practice, education, or training.”