New Client Information

Referral Process and Insurance Policies

Patients may be self-referred or referred by physicians, third-party payers, or other health-care professionals. Please contact us if you have specific questions or concerns about the therapy needs of your child. Alaska Pediatric Therapy accepts most major insurances including Denali Kid Care, Medicade, Blue Cross, Aetna, EBMS, Cigna, TriCare, United Health and others. Pre-authorization and filing of insurance are services provided as a courtesy for patients. New patients are encouraged to complete the information forms located on this page prior to your first therapy session.

New Client Forms

For new clients please complete the new client information forms listed below. Please contact the office if you need assistance. Click the link to download the file.

Intake Form

This will supply us with the information we need to get started with your child’s therapy services.

Consent for Release of Patient Information

This gives us permission to release records to physician’s offices or other parties at your request.

HIPAA Medical Disclosure

This notice describes how medical information about you may be disclosed, and who you may access this information. Please also download the HIPAA signature form.

Emergency Medical Release

Should your child require medical treatment during a therapy session this Authorizes Alaska Pediatric Therapy to contact emergency medical personnel.

HIPAA Communications Consent

Alaska Pediatric patient consent to electronic communications