Patient Forms & Insurance Information
Forms and Insurance
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 OB Letter
• Recommended Screening Test
• Ob Health History
• Personal Health Information
• Billing Practices
• * Disclosure of Info Incoming
• * Treatment of Minors
• * Eagle River Map
• AWC Patient Survey
Annual Packet
For returning patients to our clinic, please complete prior to appointment time.
• Annual Letter
• Health History
• Personal Health Information
• Billing Practices
• * Disclosure of Info Incoming
• * Treatment of Minors
• * Eagle River Map
• AWC Patient Survey
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.
• Disclosure of Information (Incoming)
• Disclosure of Information (Outgoing)
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. 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.
Click here for a list of names, phone numbers and websites of the insurance companies that we are contracted with to assist you in obtaining the information you will need. We encourage you to call and inquire about your insurance plan and benefits specific to your plan, so that you feel educated & confident with what your insurance will cover and what your portion of the services may be prior to your first visit to our office.