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Wyoming Forms

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

The following forms are for use at clinic locations in Wyoming —
Cody, Greybull, Lovell, Powell and Sheridan. 

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
Patient Information/Forms
FSHCAA Deemed Health Center
Health information technology badge
Patient centered medical home badge

© 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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