Call Today For an Appointment
(907) 344-0200

Hillside Family Medicine
& Occupational Medicine

Hillside Family Medicine
& Occupational Medicine

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Patient Forms

New Patient Registration Forms

To save time in our reception area, please fill out the following forms and bring them with you to your scheduled appointment:

Release Forms

  • Permission to treat a Minor:
    Hillside Family Medicine must receive permission from a child's parent or legal guardian before providing treatments for an injury or illness that is non-life threatening. This form gives us legal permission to treat your child in case you cannot accompany him/her to the clinic for treatment. If the party accompanying your child (baby-sitter, friend, relative, etc.) does not present this information the clinic will attempt to contact you to request permission to treat your child. If unable to reach you the appointment may be rescheduled. Thank You.
  • Medical Records Release:
    Please fill out and submit for all medical records requests.
  • Personal Health Information Release (PHI):
    This release is not required but if you would like someone other than yourself to have access to your medical records such as a spouse or parent please complete this release. This release does have some restrictions, see form for details.

Clinic Forms

Please fill out the following forms if requested/relevant:

 

Hillside Family Medicine

Address:
9220 Lake Otis Parkway, Ste 9
Anchorage, Alaska 99507
Map & Directions

Phone:
907-344-0200

Fax:
907-344-0214

Email:
staff@hillsidemedicine.com

Hours of Operation:

Mon & Wed: 8AM–6PM
Tues & Thurs: 8AM–8PM
Fri & Sat: 8AM–4PM
Sunday: Closed

Closed For Lunch: 12PM-1PM