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NEW PATIENT REGISTRATION:
HOURS:

Monday through Friday

7:00 AM - 6:00 PM

HIPAA:

Moose Creek Medical Clinic LLC is required by law to maintain the privacy of and provide individuals with the notice our legal duties and privacy practices with respect to protected health information. You will be provided a copy of our HIPAA Privacy Rules at your initial visit. For further information, please visit 

https://www.hhs.gov/hipaa/index.html.

• General Family Practice

• General Cardiology

• Management of High Risk Disease States

• Weight Management

• Cryogenic Therapy

• Wellness Exams

• Men’s Health

• Women’s Health

• Pediatric Health

• Functional Medicine

• Fascial Distortion Model

• Botox® Injections

(Therapeutic & Cosmetic)

• Sports Physicals

• DOT Physicals

OUR SERVICES:
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Click the link below to digitally fill out and submit your registration. Note that at the bottom of each page is a "Save and Continue Later" button. You can save your progress should you get interrupted while completing your forms and a secure link will be emailed to you so you can continue and finish the forms later.

 

We strive to provide the best patient experience in the clinic and request that these forms be completed several days before your appointment. This helps tremendously with our daily work flow and keeps all our patients being seen on schedule.

The last tab of the registration process is our Authorization for Release of Information. This allows us to request you medical records from your previous care provider. If you feel we should have records from other specialists or hospitals please download, print and complete as many as necessary. You can then fax them to the facilities or bring them to us and we will be happy to fax them for you.

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• Authorization for Release of Information Form (1 Page)

IMPORTANT PATIENT INFORMATION

Our office will be closed on the following holidays: New Years Day, Memorial Day, 4th of July/Independence Day, Labor Day, Thanksgiving Day, the day after Thanksgiving, Christmas Eve, Christmas Day, New Years Eve and New Years Day. Please plan accordingly.

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In the event of bad weather or treacherous roads our office will phone you to reschedule your appointment. We live in Alaska too and the safety of our patients and staff is at upmost importance.

 

In the event your healthcare status needs addressed urgently on these days,

please rely on emergency services.

Patient Rights:

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  1. Respect for the privacy of your personal health information (PHI).

  2. Be treated with respect.

  3. Participation in all medical decisions and treatment options.

  4. Receive prompt and appropriate referral for needed services.

  5. Be provided with awareness of possible complications and side effects of recommended treatments.

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Patient Responsibilities:

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  1. Keep and be on time (or early) for appointments. Take note of the cancellation policy.

  2. Treat all staff members with respect.

  3. Follow treatment recommendations and treatment plans.

  4. Immediately report any complications from treatments or if you decide to stop any medications.

  5. Seek attention at an Urgent Care/Emergency Room if you are having healthcare issues that need addressed and our office is closed.

  6. Follow recommendations for referrals/diagnostics.

  7. Complete necessary forms for compliance with privacy regulations, Moose Creek Medical Clinic LLC Patient Policies, and Release of Information.

  8. Bring a list of all of your medications (strength and dosages) to every single office visit, or bring all of your medications with you to your appointment.

If you would like to print the new patient registration to fill out by hand please click the link below. After you have completed the forms, please either drop them by our office or fax them to 907-373-3331 several days before your appointment.

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• New Patient Registration Forms (10 Pages)

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