Anchorage Osteopathic Medical Clinic
Downloadable Medical Forms
If you are a new patient coming to see us and want to print and fill out the forms prior to visiting us, please click on each link to open each form. These forms are also available at our clinics; you do not have to print them out beforehand. If you do not have Adobe PDF Reader, click here and download your free copy (to read the forms). Please note that some of these files are large and may take some time to open.
Alaska Medical Clinic Forms (used by both of our clinics - Dimond Medical Clinic and Wasilla Medical Clinic):
ALASKA MEDICAL CLINICS FORMS:
- Patient Information Form (1 page)
- Report of Medical History Form (2 pages)
- AMC Billing Policy (1 page)
- AMC Notice of Privacy, Consent, and HIPPA (1 page)
- AMC Authorization and Consent to Treat a Minor
- AMC Notice of Privacy Practices (2 page HIPPA information)
- AMC Authorization to Disclose Medical Information
SCHOOL DISTRICT FORMS:
- Alaska School Activities Association Health Information Form (School Physicals) (2 pages, 1 for parents, 1 for physican) or see this link: www.asaa.org
- Mat-Su School Physical Information Form & Mat-Su Schools Athletic/Activities Registration Form
- Anchorage School District Physical Exam Form for School Entry
- Anchorage School District Activities/Athletics Form
STATE OF ALASKA FORMS:
Dimond
Medical Clinic
300 East Dimond Blvd.,
Ste. 12,
Anchorage, AK 99515
907-341-7757
Wasilla
Medical Clinic
1700 E. Parks Hwy., #200,
Wasilla, AK 99654
907-373-6055
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