Diabetes and Lipid Clinic of Alaska

 

 


New Patient Forms

The forms on this page are intended for new patients. They are provided here so that you may print and complete them before your visit in order to reduce your time in the waiting room. These forms are in PDF format. You will need Adobe Reader or other compatible software in order to view and print them. The New Patient Package is required for all new patients. The history forms are specific to the reason for which you are seeking treatment. Only complete the applicable history form. If you have questions please call us at 907-274-7847

New Patient Package
Contains: Patient/Insurance Information Forms, Payment Policy, Privacy Practices (HIPAA)

General Health Questionaire

Diabetes History

High Cholesterol History

Hypertension (High Blood Pressure) History

Nutrition History