NOTE:  All required forms, including any insurance information, needs to be brought to your first appointment, or we may need to reschedule your appointment for a later date. There probably will not be enough time for your appointment if you arrive at your appointment at the scheduled time without your paperwork in hand, filled out, so put it where you will not forget to bring it with you.  You may submit electronically to valerie@triggerpointrelief.com. 

Patient Information
This will take about 5-10 minutes to complete.

Patient Care Financial Agreement
This will take about 5 minutes to read and complete.  Please call in advance for a financial consultation to get estimated charges so you know what to expect.  For insurance information, go to InsuranceInformation.html. 

Medical History Form  Please only print one-sided!
This will take about 30 minutes to complete, depending on the number of health conditions you have. The more completely you fill out the form, the better I can diagnose and treat you, and the more value you will get from your appointments.  Please only print one-sided!  It MUST be one-sided for scanning and FAXing purposes (archiving, records releases, insurance requests, etc), in case I ever need to do that.  If you bring in a two-sided copy, I will need to turn it into a one-sided copy, and the other side "bleeds through," and the copy won't be as good a quality.  Please change your printer settings to one-sided!

HIPPA Notice of Patient Privacy Policies
This will take about 5 minutes to read (you do not need to print it off).

HIPPA Consent Form
This will take about 5 minutes to read and complete. I legally have to have this consent form per U.S. HIPPA statutes.

Patient Information and FAQ's  This will take about 10 minutes to read and contains important information about the course of treatments and what you can expect from this clinic.

For Personal Injury Cases Only (i.e. auto accidents):

Assignment & Instruction for Direct Payment
This will take about 5 minutes to read and complete.  This instructs the insurance company to pay Alaskan Acupuncture directly.

Power of Attorney to Endorse Insurance Checks
This will take about 5 minutes to read and complete.  This allows Alaskan Natural Care Inc. to deposit any insurance checks that are either made out to the patient only, or checks that are issued jointly to Alaskan Natural Care Inc. and the patient.

Notice of Practitioner's Lien
This will take about 5 minutes to read and complete.  If you are represented by an attorney, this instructs your attorney to pay your treatment bills if the payment is made to him/her instead of this office.

Rescission of Attorney Assignment of Benefits
This will take about 5 minutes to read and complete.  This directs the insurance company to pay Alaskan Natural Care Inc. directly for your treatment bills, rather than your attorney.