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. A parent/legal guardian is required to attend a minor's first visit. 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:

Pay My Bill

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

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