Medical Park Family Care
Open Mon-Fri 7:30am-6pm • Saturday 9am-2pm
907-279-8486
Medical Park Family Care
Mountains

Printable Documents

Medical Patient Forms:

patient forms

Patient Redistration

General demographic and insurance information.

Communications

Tell us how how to contact you.

HIPAA Privacy

This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Release of Information

Permit us to receive medical records from previous or other providers, if applicable.

Medical History

Share your medical history with your provider team.  Please note these forms are age specific.

Parental Consent

Indicate your preference regarding who may bring your child for medical care and whether we may see your older child without you present.

Diabetes Care Patient History:

Financial Policy

Know what to expect regarding paying for your care.

Permit us to receive drug and alcohol treatment information, if applicable.

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