Please contact our office at 907-562-0001
for an appointment.
We are unable to see anyone on a walk-in basis.
When you call us for the first time, you will be asked a few simple screening questions. Please be as specific as possible with your answers. This will help us determine if we are able to safely and adequately address your needs. It is helpful if you have a referring provider who can send us a faxed or written request for referral or consultation. Also, please make arrangements to have any prior pertinent medical or psychiatric records sent to us prior to your appointment. In some instances we may require those records prior to scheduling an appointment.
Once you have a scheduled appointment, it is crucial that you plan to be on time. We recognize that our registration process is somewhat lengthy. However, it provides us with important information that is crucial to make an accurate assessment. If you would like, please feel free to download our registration packet and complete it at your own pace prior to your appointment. Let us know when you have completed the registration paperwork, so that we may adjust the arrival time for your first visit.
If your registration process is not completed in a timely manner prior to your scheduled appointment your appointment may be rescheduled. Your patience is appreciated.
In addition to filling out and providing the forms below, please bring a valid ID and insurance card to the appointment.
Patient Registration Form
Review of Symptoms
Consent for Telemedicine
Patient Care Contract
Consent for Treatment Form
Screening Tools Part A
Screening Tools Part B
Good Faith Estimates
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate and the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers
, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.