for new clients, please fill out the Health Information (#1) and the Client Agreement (#2) forms below (paper clip in a circle)
for new clients seeking to bill insurance, please fill out all of the above, and there is a Referral form (#3)
that will be needed from your referring doctor for the ICD-10 code
for any insurance or billing questions, please contact my biller Jennifer Thompson: ph 907.903.2634 or email:
the Retrain Pain (#4) worksheet is for, but not limited to: anyone dealing with chronic pain and the worksheet frames questions in a helpful way, for any chronic or auto immune conditions, and recovery from surgery and/or injury
PLEASE EMAIL OR FAX ALL FORMS TO:
this is an encrypted email that is HIPAA compliant, and will keep your personal information secure.
I am striving to be as paperless as possible, so would value your help with this. If you are unable to fill pdf's out electronically, please let me know when booking, to allow for some extra time to fill out prior to your appointment