Pre-Appointment Paperwork

Appointment made? Great! If you’re able, please download and complete the following paperwork prior to your appointment. You can either download, fill out the paperwork online, and then email it to ph@tetoncountywy.gov, OR, download, print, and fill out the paperwork by hand, bringing it to your appointment. If you want to email a filled PDF to us but don’t have Adobe, you will have to type in your answers, go to print>save as PDF>then email the PDF to us. 

If you do not feel comfortable filling out the paperwork online and emailing it to us, or you do not have access to a printer, please come to the Health Department prior to your appointment to obtain your paperwork. You can come anytime (call first: 307-733-6401) Monday - Friday, 8AM to 5PM, before your appointment, pick up your paperwork, and take home with you to fill out. OR you can come shortly prior to your appointment, grab your paperwork, and fill it outside or in your vehicle. If these options don’t work for you, you can also call us and we can fill out the paperwork for you, over the phone. 

You will need to click on and then download two forms, the Risk Assessment and the Consent to Services. 

Click here to download the Risk Assessment. 

Click here to download the Consent to Services (there is both English and Spanish - fill out only one side/language)

Click here to read the Notice of Privacy Practices

Filling out your paperwork before your appointment ensures a more efficient and timely clinic experience, allowing us to best meet your needs while working towards the health and safety of you, our staff, and our community as a whole.