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HealthWorks offers medical, dental, mental health & pharmacy services— for everyone!

From the provider you see for your visit, to the friendly technicians at our in-house pharmacy, you’ll feel welcome right away.

First things first: Let’s get you the paperwork you need!

You’ll find our patient registration packet here at the top, and supporting documents you’ll need for proof of income (if applying for the sliding fee scale) just below.

Once completed, you can bring your paperwork to your first appointment, or submit beforehand via:

  • Email
  • Fax: (307) 635-1442
  • Mail, addressed to:

2508 E. Fox Farm Rd., 1A
Cheyenne, WY 82007

Patient Registration Packet

Please download and fill out this paperwork if you are a new HealthWorks patient at our clinic or mobile clinic. (We can’t wait to meet you!) 

Applying For Our Sliding Fee Scale

To make health care affordable, we offer a sliding scale fee structure for our income-eligible patients. 

If you are applying for the sliding fee scale, please mark “Y” for yes at the top of your paperwork and be sure to complete and sign the “Additional Financial Household Members” pages.

To view a list of the supporting documents you’ll need to provide with your application, download the checklist below.

Supporting Documents for Proof of Income

For questions about these documents, please call our office at (307) 635-3618 and ask to speak with an eligibility specialist.

If you are currently experiencing homelessness:

Please complete the Self-Attestation of Experiencing Homelessness form.

If you cannot obtain your paystubs:

Please have your employer complete the Employer Statement form.

If you do not submit taxes: 

Please complete Form 4506-T.

If you need to obtain an IRS Verification of Non-Filing Letter: 

Read the instructions for obtaining the letter below.

If you are self-employed:

Please complete the Self-Employment Business Ledger form.

If you are unable to complete the Self-Employment Business Ledger form:

Please complete the Self-Employment Statement form.

If you receive support from individuals or an agency:

Please complete the Attestation of Circumstances form. 

Request Medical and Dental Records

Request to release information to HealthWorks

If you are releasing medical records from another healthcare organization to HealthWorks, please download and complete this form.

Request for HealthWorks to release information

If you would like to request a copy of your medical and/or dental records, or request that we send your medical and/or dental records to another facility, please complete this form and return to our office.

Nurse discussing chart with patient
Woman testing teen boy's reflexes during sports exam

Important Information About
Our Payment Policy

In an effort to make our services available to as many patients as possible on an affordable basis, HealthWorks employs a firm payment policy. To learn how the services from HealthWorks will be provided to you in an affordable way, please read the policy below.

Good Faith Estimates

If you don’t have insurance, or do have insurance and are choosing not to use it to pay for your care at HealthWorks, please let us know in advance so we can provide a good faith estimate of your expected charges. You may choose not to use insurance if the service you need isn’t covered, or it’s less expensive if you pay out of pocket.

In most cases, we can give you an estimate when you schedule care at least 3 business days in advance, or if you ask for one.

If your bill is at least $400 more than the good faith estimate we provided, you can dispute your bill.

To learn more about good faith estimates, visit

pharmacist explaining medication to patient
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Do you have questions about your paperwork?

We’re here to help! Please call (307) 635-3618 to speak with someone from
the HealthWorks team.