406-556-8300

Location

7720 Shedhorn Dr.
Suite D
Bozeman, MT
59718-8108

North of Huffine and East of Jackrabbit, near the Four Corners intersection

Mapquest Map

Office Hours

Monday – Thursday
9 am to 5 pm
& by special appointment

 

 

                                 PATIENT FORMS
                                        



 

If you would like to avoid completing forms at the time of your appointment, please consider printing and filling out the forms below to bring with you, or you may mail them to us ahead of time. (Note: One set is for adults, and one for children) 

Notice of Privacy Practices form 

The Notice of Privacy Practices form is for you to read and keep—nothing to fill out. However, you are asked to sign and date the bottom of the Registration form that indicates you have been provided with a copy of our Notice of Privacy Practices form.


ADULT New Patient Forms

CHILD New Patient Forms

 

To expedite getting medical records from previous providers, complete the following release form (Authorization for Uses & Disclosures of Protected Health Information form) below for records and either drop it off at our office or mail it to us. We will make every effort to obtain and review records before your visit. Please note: we only need the practice name, street name (if you know it), city and state on the form. We can obtain the complete address, phone number and fax number.

Authorization for Uses & Disclosures of Protected Health Information (PHI) form
 

Insurance: If we do not already have your insurance information (if applicable), please call our office with that information before your visit so that we can obtain policy details applicable to your visit.