Forms

New patient forms and more

New Patient Paperwork

All new patients must fill out the New Patient Paperwork before being seen. Patients 17 and under will need to have these forms filled out by a parent or guardian.

New Patient Paperwork

 

Minor Consent to Treat

Complete this form to authorize your minor child (age 17 and under) to be seen with another adult present or by his/her self. This form must be completed in the presence of a MGA employee unless it is notarized.

Minor Consent to Treat

 

Sports Physical

Complete this form if your minor child is being seen for a sports physical.

MSBSD Sports Physical Form.pdf –

Sports Physical Paperwork

 

Well Child Questionaires

Well Child Check Questionaires: Share your childs ASQ results securely and conveniently with your childs medical provider via a confidential online portal. Ages and Stages Questionnaires (ASQs) are a key part of your childs standard well child exams from ages 2 months through 5 years. We encourage parents to complete and submit these age-appropriate developmental screening questionnaires through the secure link below prior to the child’s exam:

Wasilla Online Screening     Eagle River Online Screening

 

Medical Records

Once received, your request will be processed and may take up to 14 business days.
The records can be mailed, faxed, or picked up from the clinic; please mark your preference on the form.

Medical Group of Alaska
Attn: Medical Records
3066 E Meridian Park Loop Suite 3
Wasilla, AK 99654
PH: 907-357-9590
FAX: 907-357-9593
E-mail: records@medgroupAK.com

Release of Information

 

Copies of Medical Records

Due to the high volume and time consuming nature of requests, MGA has implemented the charges below for Medical Records.

PAPER COPIES ELECTRONIC FORMAT

1-25 pages: FREE Disc: $15.00
26-50 pages: $20.00
51-75 pages: $25.00
76-100 pages: $30.00
100+ pages: $40.00

*Charges will not exceed $40.00 and payment will be due prior to records being released.

The offices of MGA will not charge a fee for processing requests for releases to medical insurance companies or for Workers’ Compensation.

If you are discharged from a MGA clinic, your records may be provided to you on a one time basis at no cost.

WASILLA

3122 E Meridian Park Lp
Wasilla, AK 99654
Phone: 907-357-9590
Fax: 907-357-9593

URGENT CARE

3066 E Meridian Park Lp
Wasilla, AK 99654
Phone: 907-357-9560
Fax: 907-357-9596

PALMER

561 S Denali St
Palmer, AK 99645
Phone: (907) 745-9088

EAGLE RIVER

17025 Snowmobile Ln
Eagle River, AK 99577
Phone: 907-694-9553
Fax: 907-694-9585

ANCHORAGE

4361 Boniface Pkwy
Anchorage, AK 99504
Phone: 907-333-2133
Fax: 907-333-2139

EXPRESS

320 W. 5th Ave Ste 152
Anchorage, AK 99501
Phone: 907-929-1340
Fax: 907-333-2139

WASILLA

3122 E Meridian Park Lp
Wasilla, AK 99654
Phone: 907-357-9590
Fax: 907-357-9593

URGENT CARE

3066 E Meridian Park Lp
Wasilla, AK 99654
Phone: 907-357-9560
Fax: 907-357-9596

PALMER

561 S Denali St
Palmer, AK 99645
Phone: (907) 745-9088

EAGLE RIVER

17025 Snowmobile Ln
Eagle River, AK 99577
Phone: 907-694-9553
Fax: 907-694-9585

ANCHORAGE

4361 Boniface Pkwy
Anchorage, AK 99504
Phone: 907-333-2133
Fax: 907-333-2139

EXPRESS

320 W. 5th Ave Ste 152
Anchorage, AK 99501
Phone: 907-929-1340
Fax: 907-333-2139
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