University of Wyoming Logo
UW Family Medicine
Contact Us

820 East 17th Street

Cheyenne, WY 82001

Phone: 307-632-2434

Fax: 307-634-7691


New Patient Paperwork

Please print and bring completed forms to your appointment.

Por favor, imprima y llene los siguientes formularios para traerlos a su visita.

Picture of a form

New Patient Welcome Packet

New Patient Welcome Packet
Picture of a form

New Patient Registration Form

New Patient Registration Form
Picture of a form

Patient Service Agreement

Patient Service Agreement
Picture of a form

Authorization for Use and Disclosure of PHI

Authorization for Use/Disclosure of PHI
Picture of a cowboy hat

Notice of Privacy Practices

Notice of Privacy Practices
Picture of a form

Sliding Fee Scale Application

Sliding Fee Scale Application
imagen de papel

La Comunidad Beneficia a la Aplicación

La Comunidad Beneficia a la Aplicación
imagen de papel

Notificacion de Practicas de Privacidad

Notificacion de Practicas de Privacidad
 

 

Contact Us

820 East 17th Street

Cheyenne, WY 82001

Phone: 307-632-2434

Fax: 307-634-7691