Patients

Alaska Foot and Ankle Specialists is committed to making your office visit, an easy and comfortable experience. Below are external web links and PDF copies of our patient forms. The PDF forms below were created for your convenience and require a copy of Adobe Reader software installed on your computer. Download a free copy of Adobe Acrobat.

Interactive PDF Forms & Instructions:
1. Click on the file name below to download a copy to your computer.
2. Open the interactive PDF file in Acrobat software.
3. Make sure the interactive form fields are highlighted for ease-of-use.
4. Enter all applicable information in the interactive PDF form.
5. Print a copy, complete any sections requiring handwritten responses then sign and return to our office at your next scheduled visit.

• New Patient Form revised 7/2016 (Interactive PDF)

Release of Patient Records Form & Instructions:
Fax or mail the completed form to our office for records release processing.
Health Records Release (Interactive PDF)

Authorization to Treat Minors Form & Instructions:
Please return the completed form below to our office at your next scheduled visit.
• Authorization to Treat Minor in Absence of Parent/Guardian (PDF)

Privacy & Financial Policy Forms:
Notice Of Privacy Practices revised 5/2016 (PDF)
Patient Financial Policy Sheet (PDF)

External Web Links:
Alaska Surgery Center Patient Pre-Registration
Alaska Regional Hospital Admitting Procedures
Providence Alaska Surgery Services