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. 


Sliding Fee Scale English Version

Sliding Fee Scale Spanish Version



HealthWorks Intake Application English Version (Needed to apply for the Sliding Fee Scale)

HealthWorks Intake Application Spanish Version


HealthWorks New Patient Registration English Version (Need for all new patients)

HealthWorks New Patient Registration Spanish Version


Credit and Collection Policy English Version
Credit and Collection Spanish version


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 option 1 to schedule an appointment or to get additional information.

New Patient Forms

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 911 NOW.



PHONE
307-635-3618

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2508 E. Fox Farm Rd. 1-1A
Cheyenne WY 82007