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.

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

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

Click here to review our Credit and Collection Policy

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.