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
Instructions on how to obtain an IRS Verification of Non-Filing Letter "Click Here"
Please Call to schedule an appointment or to get additional information.
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.
2508 E. Fox Farm Rd. 1-1A
Cheyenne WY 82007