Please fill out the following forms before your visit. Click on the PDF link and download a printable copy to bring in with you to our offices. If you are unable to print out the forms, please call our office and we will be happy to provide them to you. Thank you!

Dr Lane Smothers - New Patient Forms

Dr Laura Smothers - New Patient Forms

HIPAA Notice of Privacy Practices

Release of Private Health Information FROM Casper General Surgery PDF

Release of Private Health Information TO Casper General Surgery PDF

Please note that we now require a copy of your Medicare, Medicaid and/or Insurance Card to verify the mailing address, phone number, and the spelling of your name as shown on each individual card. We cannot file insurance claims for you without the birthdate of the policy holder.

We are also requiring a copy of your driver’s license or other picture ID that includes your signature. This is to verify your identity in the event of requests for release of Private Health Care information.

We appreciate your help and understanding of these requests.