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Western Montana Forms

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

The following forms are for use at clinic locations in Western Montana — Belgrade, Bozeman, Livingston and West Yellowstone. 

ONLINE PATIENT INFORMATION/FORMS

Online forms for both new patients and patients who have visited clinics in Western Montana before are below.

 

If you prefer to print and fill your forms and bring them to your appointment, please click here.

Guarantor and Insurance Update (Returning Patient)

Please select the clinic where you have scheduled an appointment to complete your Guarantor and Insurance Update online.

Medical Records

You may request your medical records from Western Montana One Health clinics using any of the options below:

  1. Fill out our Medical Release of Information online form

  2. Use MyChart

    1. You can download or create requests for copies of your medical records through the Sharing Hub inside MyChart. Simply tap the menu in MyChart and find to the Sharing Hub.

    2. If you do not have My Chart: select the link to sign up for My Chart.

  3. Print out our Medical Release of Information form and send it to:

19 E. Main Street

Belgrade, MT, 59714

 

If you have questions or want to be sure you have prepared everything that is required to get the records that you are looking for, call our Medical Records Department.

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.​

FSHCAA Deemed Health Center
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© 2025. One Health.

This health center is a Health Center Program grantee under 42 U.S.C 254b of the United States codes,

and its providers and staff are deemed to be Public Health Service employees under 42 U.S.C 233 (g)-(n).

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