We have compiled the forms and information you will need for your appointments and billing issues. If you do not see what you need you may contact our office to obtain that information.

*Optional pages, please review page first before printing. All other forms should be printed out, completed and faxed to 907.771.8502 attn: “Preload” prior to date of appointment.

New GYN Patient

For new patients, please complete prior to arriving at our clinic.


New OB Packet

For new or returning patients who are pregnant or expecting, please print and complete each form listed below prior to arriving at our clinic. If you are an OB patient, and are under the age of 18, please complete the Minor Statement as well.


New Counseling Packet

Please complete these two forms, in this packet, prior to your first visit with one of our counselors.

Annual Packet

For returning patients to our clinic, please complete prior to appointment time.


Medical Record Release

For patients requesting medical records to be sent to their provider at AWC or for patients wishing for us to send private medical information.


Minor Patient Statement

For young women of minor age and their parents who agree to Anchorage Women’s Clinic Position Statement and who will consent to treatment and confidentiality by AWC.

Insurance

Anchorage Women’s Clinic is committed to providing you the best patient service possible. We understand the importance of billing insurance companies for patient services, which is why we are preferred providers with some insurance companies.  View insurance companies we are contracted with >>

In order to facilitate the billing process, please be willing to provide us with all of your insurance information, as well as complete the pre-registration process.

We will bill your insurance, based on the information you have provided, and will collect any estimated portion that your insurance will not cover, such as: deductibles, co-pays and or patient required percentages at the time services are rendered. Our billing department will make every effort to collect from your insurance company, however, sometimes you are left with a balance that you will be responsible for paying in full.

We encourage you to call and inquire about your insurance plan and benefits specific to your plan, so you feel educated and confident with what your insurance will cover and what your portion of the services may be prior to your first visit to our office.