University of Wyoming Logo
UW Family Medicine
    Contact Us

    820 East 17th Street

    Cheyenne, WY 82001

    Phone: 307-632-2434

    Fax: 307-634-7691

    Email: uwfmcb@uwyo.edu


    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 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

    Email: uwfmcb@uwyo.edu