Client Forms & Privacy Info

Client Resources:

We use a HIPAA-compliant vendor to securely deliver client forms submitted through our website.

For Established Clients

We are currently transitioning to a new Electronic Health Record, and many forms are able to be completed through our new client portal. You will receive an email  from our Client Access staff for any forms that need completion prior to your next appointment.

MyHealthPointe

Intake Forms

Child Intake Form

Adult Intake Form

Intake Form for OCS and OPA guardians

Update Client Contact Info

You may also download  PDF Forms, complete and fax to 907-375-3115, deliver to any Alaska Behavioral Health location, or mail to:
Alaska Behavioral Health
Attention: Clinical Records
4020 Folker Street
Anchorage, AK 99508

Forms for Legal Guardians

Adults who provide day-to-day care for children in OCS custody will need to be named in a Release of Information to access health care information. Those wishing to access information about an adult family member or an adult ward must also be named in a Release of Information form.

  • State of Alaska OPA and OCS guardians, please complete the Guardian Intake Form for any clients you are referring for services.
  • If you are the legal guardian for an adult client, please assist them with completing the paperwork and scheduling appointments.

Authorization to Release Health Information (ROI)

Send us your files!

Insurance/Payment Forms

Sliding Fee Scale Application

AKBH Rates for Most Common Services

Release of Information Forms

Authorization to Release Health Information (ROI)

Emergency Contact Release of Information

Request to Access to or Copies of Records 

If you are a client and are requesting a copy of your own records, please complete the Request to Access Form.

Consent Forms

Consent for Services/Telehealth & Data Collection

Consent for Electronic Communication

Consent to Record Treatment

Treatment Forms

Treatment Plan Acknowledgement Form 

Safety & Wellness Plan Acknowledgement Form

Consumer Procedures

Consumer Safety Guidelines and Procedures

Consumer Grievance Process

Consumer Grievance and Complaint Form 

  • You may also download the Consumer Grievance Form – PDF ,  complete it and fax it to 907-375-3115, deliver to any Alaska Behavioral Health location, or mail it to:
    Alaska Behavioral Health
    Attention: Clinical Records
    4020 Folker Street
    Anchorage, AK 99508

Privacy Notices

Notice of Privacy Practices

Notice of Privacy Practices – Spanish

Notice of Privacy Practices – Hmong

Homeless Management Information System Consumer Privacy Notice – Alaska Behavioral Health utilizes the HMIS during outreach in the PATH program and with current clients on the Assertive Community Treatment (ACT) Team and the 811 Housing Team.