Client Forms & Privacy Info

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

Intake Forms

Child Intake Form

Adult Intake Form

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

If the State of Alaska is referring a child for services and has legal custody of the child, please complete a Release of Information for the adult who provides day-to-day care for the minor child. 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)

Insurance Forms

Advanced Beneficiary Notice for Clients with Medicare

Sliding Fee Scale Application

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, you will need to fill out both the ROI and this Request for Access Form.

Consent Forms

Consent for Services & Data Collection

Consent for Services by a Student Intern 

Consent for Telehealth

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.