top of page

Records Release
Scott Wyman MD, Diana Podlecki PA-C

Courtney Hathaway MD, Jeanne Bloom FNP, Brandi Glibbery FNP

Hometown Family Medicine Paperwork
Courtney Hathaway MD, Jeanne Bloom FNP, Brandi Glibbery FNP

Hometown Women's Health Paperwork
Scott Wyman MD,  Diana Podlecki PA-C

Patient Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

 

Download Patient Forms

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.

​

Patient Medical History Forms

New patients, please print the following 3 forms, fill out and send into our office prior to your appointment via fax or on-patient portal. If this can not be done, please bring forms to your appointment filled  out or arrive 30 minutes early to enable you to complete forms prior to your appointment.​

​

Office Policies

 

Appointments

Appointments can be made by calling my office during normal business hours at 406-926-1088

​

  • Monday – Thursday 7:30 am - 5 pm  

  • Friday 7:30 am - 4:30 pm

​

We require a $50.00 credit card hold on your first appointment this fee will not be charged unless you do not show up for your appointment or same day cancellations.

 

After Hours & Emergency Care

If you are experiencing an emergency, dial 911 or head to the nearest emergency room. For all other calls, an on-call physician is available 24-hours a day, 7-days a week.

 

Prescription Renewals

Prescriptions are renewed during normal office hours and we request 72 hour notice on prescription refills. In some instances, we may require that the patient be seen in our office prior to medication renewal.

 

Financial

All office visits are payable at the time of service. If you receive text message reminders you will receive an estimated cost based on your current insurance benefits. We accept cash, checks, Visa and MasterCard.

 

Please contact our billing department should you have any financial questions or concerns.

bottom of page