Sign In
Skip to content
Attention: We are updating our website to better serve Alaska. Please let us know if you experience difficulties navigating our webpages or accessing our information.
 

Locations  

Forms  

Services  

 

Registration Forms

Download, print, and fill out the forms that you will need for your appointment.

  • ALL patients need to fill out forms 1, 2, and 3.
  • Fill out additional forms as instructed by Public Health Nursing Staff.
  • Call for an appointment. (Find a Public Health Center)

PLEASE DO NOT EMAIL the forms; they contain your Protected Health Information.

  1. Client Registration Form
  2. DHSS Acknowledgement of Privacy Notice (06-5876) 09-03
  3. DHSS Notice of Privacy Practices