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

Patient Forms

PATIENT REGISTRATION FORMS

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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