Referral Process &
Insurance Policies

Patients may be self-referred or referred by physicians, third-party payers, or other health-care professionals. Please contact us if you have specific questions or concerns about the therapy needs of your child. Alaska Pediatric Therapy accepts most major insurances including:

• Denali Kid Care
• Medicaid
• TEFRA
• Blue Cross
• Aetna
• EBMS
• Cigna
• TriCare
• United Healthcare

Pre-authorization and billing of insurance are services provided as a courtesy for patients. New patients are encouraged to complete the information forms located on this page prior to your first therapy session.

New Client Forms

For new clients: please complete the new client information forms listed below. Please contact the office if you need assistance. Click the form name to download.

Patient Intake Form
This will supply us with the information we need to get started with your child’s therapy services.

Consent for Release of Patient Information
This gives us permission to release records to physician’s offices or other parties at your request.

Client Medical Information Use Disclosure 
This describes how medical information about you may be disclosed, and who may access this information.

Acknowledgement of Receipt of Privacy Practices
Please download and sign this form to acknowledge you have received and reviewed a copy of our privacy practices.