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Initiating Services
Thank you for your interest in our clinic.
We welcome the opportunity to provide services to your child. If
you would like to schedule an appointment for an evaluation, please email
us or (907) 562-4550. In order to schedule an appointment, the
office will request that you complete a series of forms. All forms
can be downloaded from your computer. Below is a list of required
forms which must be received before evaluation time. There is also
a list of additional forms which may be required. These are available
in the "Forms" section of our site. Please
contact
the office prior to completing the forms.
Required 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.
- New Patient Information Packet (Speech)
- Privacy Notice (Read Only)
- Financial Policies / Cancellation / Clinic Information
- Release of Information
- Medical History
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