2490 S. Woodworth Loop, #450
Palmer, AK 99645
Call Us
907-745-8100

Patient Forms

PATIENT REGISTRATION FORMS

If you are not able to complete the registration process using our interactive Patient Portal, please PRINT THE PACKET and COMPLETE ALL PAGES OF THE FORMS, and bring it with you to your appointment.  Please bring a valid ID, insurance cards and a completed medication list as well.

FINANCIAL POLICY

No-Show Policy: Failure to show or cancel/reschedule an appointment without 24 hour notice will be charged a $75.00 fee.

Co-Pays are due at time of service. A copy of our full Financial Policy is available below.

MEDICAL RELEASE OF INFORMATION

NOTICE OF PRIVACY PRACTICES

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