Client Forms & Privacy Info

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

Current clients, click here to fill out and submit forms.

New clients, submit new client intake forms here.

 

Notice of Privacy Practices

Notice of Privacy Practices – Spanish

Notice of Privacy Practices – Hmong

 

Consumer Safety Guidelines and Procedures

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.

Consumer Grievance Form   NOTICE:  The Consumer Grievance Form cannot be submitted online.  The form can be hand delivered to any Alaska Behavioral Health location, faxed to 907-375-3115, or mailed to:

Alaska Behavioral Health
Attention: Privacy Officer
4020 Folker Street
Anchorage, AK 99508

Request for Access to or Copies of Records If you are a client and are requesting a copy of your own records, you will need to fill out both the ROI and this Request for Access Form.

NOTICE: The Release for Access form cannot be submitted on-line or by e-mail.  The form can be hand delivered to any Alaska Behavioral Health location, faxed to 907-375-3115, or mailed to:

Alaska Behavioral Health
Attention: Clinical Records
4020 Folker Street
Anchorage, AK 99508