New Patient Forms

Nondiscrimination Statement

HealthWorks complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Declaración de no discriminación
HealthWorks cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.



Welcome to HealthWorks!

    We are here when you need us.

      To schedule an appointment or for more information please call us at (307) 635-3618.
     If you are experiencing severe symptoms, please call 9-1-1 NOW.

The form below is required if you are applying for our sliding fee scale.  You will also need to schedule an intake appointment to go over the form with our intake staff. 

Click Here For Our Sliding Fee Scale

Full Intake Package - English

Full Intake Package - Spanish

Instructions on how to obtain an IRS Verification of Non-Filing Letter "Click Here"

Link to IRS Form 4506-T

Please Call (307) 635-3618 to schedule an appointment or to get additional information.