Fill out the above forms or please print, completed and bring in any required forms to your next appointment. 

Patient Registration -pdf (Or Complete the above online form)
Medical History - pdf 
(Or Complete the above online form)
Release of Information - pdf
Notice of Privacy Practice - pdf

 The documents above are provided in a printer friendly PDF format. A PDF viewer such as Adobe Reader is required to view the documents.

Note: We have consolidated our locations to better serve our patients in the Anchorage and MatSu areas with our Eagle River location.

Fairbanks

Eagle River

  • 12641 Old Glenn Highway # 101
    Eagle River, Alaska 99577
    Office: 844-833-7222
    907-770-2606
    Fax: 907-770-2604
    Mon-Fri: 9:00 am-5:00 pm
    Map