Big Horn Pediatrics & Family Medicine - Gillette, WY
Patient Registration Forms
and Records Request
Please print out forms and return at the time of your appointment. Please bring your insurance card to your appointment to complete registration.
Please print out forms and return at the time of your appointment. Please bring your insurance card to your appointment to complete registration.
ALL minor children MUST be accompanied by a parent or guardian to their appointments. If you are unable to attend with your child, please fill out this form to give permission to someone you trust with the medical care of your child in your absence. Please send form with your child to their appointment with their appointed adult caregiver.
If your contact information has changed, please fill out this form and return it to frontdesk@bighorn.pcc.com.
Please print out forms and return at the time of your appointment. Please bring your insurance card to your appointment to complete registration.
Print this form and send to your previous medical provider to obtain your records for continued care at Big Horn Pediatrics. You may fax records to: 307-682-1309.
If you would like your records transferred to an alternative provider, please fill out form and return to frontdesk@bighorn.pcc.com -
For all other requests please email us or call us at 307-687-1300.
Please allow 72 hours for records requests.