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Forms:
Please download any form by clicking on it below.  All forms are in Adobe PDF format which can be filled out and faxed to us at (907)562-4554.  If you don't have a PDF reader, you can get one for free by clicking HERE.  All forms are also available in their original Microsoft Word or Excell format which can be filled out electronically and emailed back to us at mary@aktherapedics.com.  In this case your signature will be obtained when you arrive at the office.  Forms which have been altered in any way other than with requested information will not be accepted.

 

 

REQUIRED FORMS New Patient Information Packet (Speech)   Click Here Click Here Privacy Notice (Read Only) Click Here Click Here Financial Policies / Cancellation / Clinic Information  Click Here Click Here Release of Information  Click Here Click Here Medical History   Click Here Click Here

OTHER FORMS Speech and Language Questionaire   Click Here Click Here Developmental Behavior Questionaire   Click Here Click Here Feeding Questionaire   Click Here Click Here Credit Card Use Permission   Click Here Click Here Stuttering Questionaire   Click Here Click Here