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What To Bring To Your Appointment

  • Your insurance card
  • Physician referral forms if required by insurance
  • A list of current prescriptions and/or over-the-counter medications you are taking - Please include your dose and frequency
  • Pertinent information about your medical and surgical history
  • Any recent x-rays or test results

    • Registration & Privacy Forms

    All patients should complete all forms:

  • Financial Policy (PDF)

  • New Patient Info (PDF)

  • Patient Info Record (PDF)

  • Medical History (PDF)

  • Medication List (PDF)

  • Review of Symptoms (PDF)

  • Notice of Privacy Practices (PDF)

  • Your Right to Privacy (PDF)

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    Medical Records Requests

    Please complete the following to request medical records from our office:

  • Release of Information  (PDF)

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    Consent Forms

    Please complete the following if you are scheduled for surgery:

  • MEDICAID ONLY: Consent for Sterilization (vasectomy patients) (WORD/PDF)

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    Insurance and Payment Information

    Alpine Urology is a provider for Medicare, Medicaid, Blue Cross/Blue Shield and Aetna and accepts most major insurance plans. As a courtesy, we do bill insurance, but your co-pay is required at the time of service.  Anything not covered by your insurance is your responsibility.
     
    For any patient billing issues, please call 907.563.3103.  Our billing department may be handling other calls so please leave a message with your contact information and we will promptly return your call.
     
    Questions regarding your coverage and benefits should be directed to your employer or insurance company.

    • To fill out forms on your computer before printing, please download the WORD versions of the forms. 

    • To fill out forms by hand or typewriter, please print out the WORD or PDF forms. To view the PDF documents above, you will need the Adobe Acrobat Reader™ plug-in. If you do not have it already installed, a free version is available through the Adobe website. Download the Acrobat Reader.

    Dr. Bomalaski Dr. Turner Dr. Godet Dr. Ferucci Anchorage Office - 3841 Piper Street, Suite T300 Tel: 907.563.3103 Soldotna office -265 N. Binkley St. - Tel: 907.563.3103 Fairbanks - 1305 21st Street, Suite 101 - Tel: 907.563.3103 Homer Ofiice - 4209 Hohe St. - Tel: 907.563.3103
    Dr. BomalAski Dr. Turner Dr. Godet Dr. Ferucci Anchorage Soldotna Fairbanks Homer

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