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.
New Patient Forms
Please select the clinic where you have scheduled an appointment to complete your New Patient Forms online.
Sliding Fee Discount Application (Returning Patient)
Please select the clinic where you have scheduled an appointment to complete your Sliding Fee Discount Application online.
Guarantor and Insurance Update (Returning Patient)
Please select the clinic where you have scheduled an appointment to complete your Guarantor and Insurance Update online.
Behavioral Health — All
Intermountain (Bozeman/Belgrade School Districts)
Medical Records
You may request your medical records from Western Montana One Health clinics using any of the options below:
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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.
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If you do not have My Chart: select the link to sign up for My Chart.
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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.