Request a Screening or Consultation

If you are having a medical emergency, call 911 for emergency medical help.

Complete the form below to request an in-person appointment or telephone consultation. A representative will contact you within two business days to assist you. We have offices in Anchorage, Fairbanks, Juneau and Wasilla.

Location

 

Contact Information

 

Requester Information

 

Verification

Location

 

Contact Information

 

Requester Information

 

Verification

Location

 

Contact Information

 

Requester Information

 

Verification