Montana Forms

Find and complete the correct forms
for your local health center.

The following forms are for use at clinic locations in Eastern, Central Montana & Western Montana — Ashland, Belgrade, Bozeman, Chinook, Glendive, Hardin, Harlem, Lewistown, Livingston, Miles City and West Yellowstone.

Patient Information/Forms

DOWNLOAD PATIENT INFORMATION/FORMS

Big Sky Care Connect

New Patient Intake Form

Release of Protected Health Information

imMTrax Consent Form

Big Sky Care Connect Opt Out

Notice of Privacy Practices

Sliding Fee Discount Program Application

Consumer Bill of Rights

Payment Policy

Sliding Fee Discount Program Information

ONLINE PATIENT INFORMATION/FORMS

Your care team may ask that you complete one of the forms below.

School-Based Care – Authorization to Disclose

This form allows for communication between the clinician, and the school district staff.

Belgrade Schools

Bozeman Schools

Behavioral Health Assessment Packet

If you have been instructed to fill out our Behavioral Health Assessment packet, please follow the link below. These assessment tools help us ensure we are providing appropriate treatment for your concerns.

Do not complete the packet unless instructed to by one of our Behavioral Health Consultants.

Assessment Packet Form