Fairbanks Psychiatric & Neurological Clinic, APC

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Forms

Please print and sign our new patient forms before your appointment. We do not offer electronic delivery. This includes the HIPAA patient consent and registration. As a reminder, please also bring your insurance and ID cards to the appointment.

HIPAA Patient Consent

Patient Registration Form

Our Release of Information documents can be filled out in case any medical records need to be obtained from a previous physician, or you’d like records sent out of our office to another physician. Please be sure to fill out as much as possible, with a signature at the very bottom. If there are any questions, our medical records clerk can be contacted at 907-452-1739.

Release of Information

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