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

Patient Forms

PATIENT REGISTRATION FORMS

We are now using Klara, a secure HIPAA compliant platform to text patient forms and appointment reminders. Patients will receive a text message with eforms & other requests that need to be completed prior to appointments. Open the link in the text to enter Klara, then confirm your identity and complete the eforms. If you have questions, please call our office, use the ‘Message us’ button, or text us @ 425-472-4156.

If you are unable to complete the patient registration eforms in Klara. Please complete the New Patient Registration Packet below:

DOWNLOAD, PRINT, and COMPLETE ALL PAGES OF THE PACKET

(The New Patient Registration Packet is a fillable form. You may choose to type your answers directly on the form instead of printing a blank form and writing your answers by hand. For best results, we suggest you download the PDF to your computer and use the latest version of Adobe Acrobat Reader rather than completing the PDF through your web browser.)

Please bring the following to your appointment:

  • Completed New Patient Registration
  • Valid ID/Driver’s Licence
  • Insurance cards
  • A complete Medication & Supplement List, including  times and dosing.

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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