We use a HIPAA-compliant vendor to securely deliver client forms submitted through our website.
Intake Forms
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/Payment Forms
AKBH Rates for Most Common Services
Release of Information Forms
Authorization to Release Health Information (ROI)
- Sample completed ROI Form
- You may also download the ROI 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
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.
- You may also download the Request for Access to or Copies of Records Form, 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
Consent Forms
Consent for Services/Telehealth & Data Collection
Consent for Electronic Communication
Treatment Forms
Treatment Plan Acknowledgement Form
Safety & Wellness Plan Acknowledgement Form
Consumer Procedures
Consumer Safety Guidelines and Procedures
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 – 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.