Family Health

Gillette Internal Medicine Associates Forms

Click on the document listed below to open a PDF document to view or to print and complete.

Notice of Patient Privacy Practice – For your information. How we protect your personal information.

New Patient Information Form – To be completed if you are a new patient to our clinic. Print the forms at home and complete them. Be certain you bring them with you when you arrive for your first visit.

Disclosure from GIMA (to send your patient information to another doctor or person)

Disclosure to GIMA (to have your patient information sent to us from another doctor)

Financial Contract – For private pay patients who need to setup a payment plan.

Family Health | 407 South Medical Arts Ct Suite D, Gillette, WY  82716-3372 | Call: (307) 686-0308  | Contact Us
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