Patient Information
Forms
New Patient Packet
New Patient Packet PDF (English) (Rev. 10/2024)
New Patient Packet PDF (Spanish) (Rev. 10/2024)
Consent for Treatment & Billing practices
Consent for Treatment and Billing Practices PDF (English) (Rev. 09/2024)
Consent for Treatment and Billing Practices PDF (Spanish) (Rev. 09/2024)
Consent for Treatment and Billing Practices PDF (Tagalog) (Rev. 09/2024)
Consent for Treatment and Billing Practices PDF (Samoan) (Rev. 09/2024)
Sliding Fee Discount Application
For an online form, send TEXT ME to 907-743-7200.
Sliding Fee Discount Application PDF (English) (Rev. 02/2024)
Sliding Fee Discount Application PDF (Spanish) (Rev. 07/2024)
Sliding Fee Discount Application PDF (Tagalog) (Rev. 05/2024)
Sliding Fee Discount Application PDF (Samoan) (Rev. 05/2024)
Dental Health History
Dental Health History PDF (English) (Rev. 9/2023)
Dental Health History PDF (Spanish) (Rev. 9/2023)
PERSONAL HEALTH INFORMATION DISCLOSURE agreement
For an online form, send TEXT ME to 907-743-7200.
Request an Appointment
To request an appointment, you can call or send TEXT ME to 907-743-7200.
Request a refill of an existing Prescription
If your prescription is at an outside pharmacy like Fred Meyer, Carrs, Walgreens, please contact that pharmacy directly.
Existing ANHC prescriptions only: Online prescription refill request form
You may also send an email to prescriptions@anhc.org or call our 24/7 refill line 907-743-7208.
Request a new Prescription
To contact your ANHC care team to request a new prescription, send TEXT ME to 907-743-7200.
Contact my Care Team
To contact your ANHC care team, send TEXT ME to 907-743-7200.
Request my Medical Records
To request that your medical records be sent to you, send TEXT ME to 907-743-7200.
Looking for your vaccine records? Download the Docket app for easy access.
Apple users: Download Docket from the App Store.
Android users: Download Docket from Google Play.
Request a Release of Information
Request that your medical records be sent to ANHC, request that ANHC send your medical records to another provider, or request a mutual exchange of information.
For an online form, send TEXT ME to 907-743-7200.
Advanced Authorization for Release of Information Request Form PDF (English) (Rev. 8/2025)
Advanced Authorization for Release of Information Request Form PDF (Spanish) (Rev. 9/2024)
Make a Care Request
Request a different provider or make a complaint about the care you received at ANHC.
For an online form, send TEXT ME to 907-743-7200.
View other feedback options.
Notice of Privacy Practices
Notice of Privacy Practices PDF (English) (Rev. 8/2025)
Notice of Privacy Practices PDF (Spanish) (Rev. 8/2025)
Notice of Privacy Practices PDF (Tagalog) (Rev. 8/2025)
Notice of Privacy Practices PDF (Samoan) (Rev. 8/2025)