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Celebrating 66 years of excellence. Non-Profit Organization founded in 1954
Gottsche Therapy Rehabilitation and Wellness

Gottsche Therapy Rehabilitation and Wellness

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  • Our Clinics
    • Basin Clinic
    • Cody Clinic
    • Meeteetse Outreach Clinic
    • Powell Clinic
    • Thermopolis Clinic
    • Shoshoni Clinic
    • Worland Clinic
  • About Us
  • Services
    • Physical Therapy
    • Occupational Therapy
    • Speech Therapy
    • Aquatic Therapy
    • Massage Therapy
  • Donate
  • Contact Us
  • Patient Forms
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  • Home
  • Our Clinics
    • Basin Clinic
    • Cody Clinic
    • Meeteetse Outreach Clinic
    • Powell Clinic
    • Thermopolis Clinic
    • Shoshoni Clinic
    • Worland Clinic
  • About Us
  • Services
    • Physical Therapy
    • Occupational Therapy
    • Speech Therapy
    • Aquatic Therapy
    • Massage Therapy
  • Donate
  • Contact Us
  • Patient Forms
  • Employment

Patient Forms

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  2. Patient Forms

Please download and print the following forms before your appointment.

Patient Forms

  • Patient Initial Exam Forms
  • Women's Health/Pelvic Health Initial Exam Forms

Wellness Forms

  • Wellness - Post Rehab
  • COVID 19 Waiver Form

Basin Clinic

  • 406 S. 4th St., Basin, WY 82410
  • 307-568-9399
  • Fax: 307-568-9396
  • swhite@gottsche.orgOpens in your application

Cody Clinic

  • 1526 Rumsey Ave., Cody, WY 82414
  • 307-578-1970
  • Fax: 307-578-1973
  • kdallman@gottsche.orgOpens in your application

Powell Clinic

  • 639 W. Coulter Ave., Powell, WY 82435
  • 307-754-9262
  • Fax: 307-754-9283
  • arodriguez@gottsche.orgOpens in your application

Thermopolis Clinic

  • 148 E. Arapahoe St., Thermopolis, WY 82443
  • 800-743-0736
  • Fax: 307-864-2857
  • cshero@gottsche.orgOpens in your application
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