Patients – Alaska Center for Dermatology

AN IMPORTANT NOTICE ABOUT YOUR CARE DURING THE COVID-19 PANDEMIC

Your care and safety are our top priorities. As we continue to provide the highest-quality patient care possible, we have implemented new safety protocols. These include but are not limited to procedures which require completing your patient paperwork prior to your appointment.

We understand that as individuals and as a community we have had to process many changes during the pandemic. Considering this, we have created a resource to help make your dermatology appointment as smooth and stress-free as possible. Please take a moment to read our Special Message to Patients Regarding coronavirus, COVID-19. Here you can find a great deal of information about our new safety measures and procedures as they relate to the pandemic.

COVID-19 PATIENT NOTICE

Make a Payment

To make a payment, please enter the requested information and click “Make a Payment”. Your information is encrypted and safe and will not be stored on the web server or any other unsecured location.

You will be emailed a receipt upon completion of payment. If you would like an itemized printout in addition to the email you will receive, please call us at 907.646.8500.

Patient Name*
First Last
Patient Email*
Phone*
Date of Birth*
Patient ID Number
Payment Amount*
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Patient Registration

We ask that you complete all the forms necessary for your medical visit prior to arriving at our location. Please download, print, and complete the forms provided below. Note that we have three versions of our Conditions of Treatment, please choose the one which applies to you.

Should you not be able to print and complete your paperwork at home, please arrive fifteen minutes before your appointment to facilitate completing paperwork which will be provided by one of our team members.

New Patient Form Packets

NEW PATIENT PACKET (MEDICARE)

NEW PATIENT PACKET (MEDICAID)

NEW PATIENT PACKET (ALL OTHERS)

New Patient Forms (Individual)

Patient Registration Form

Dermatology Intake Form

Release of Information Consent

Notice of Privacy Practices

Conditions of Treatment (Medicaid)

Conditions of Treatment (Medicare)

Conditions of Treatment (All Others)

HIPAA Policy Acknowledgement

Medicare Patients Only - MSP Short Form

Authorization to Disclose PHI

Authorization for Minor Alone

Authorization for Minor with Agent

Telemedicine Resources

Curious about how telemedicine works? Visit this page for helpful resources on how to setup and connect to an upcoming virtual telemedicine appointment with us.

To schedule your telemedicine appointment, call us at 907.646.8500.

Patient Insurance Information

We provide courtesy billing to your primary and secondary insurance carriers. To take advantage of this service, please:

Bring your insurance card(s) and government-issued picture ID to your appointment
Plan to pay your portion at the time of your appointment

Alaska Center for Dermatology is an Aetna & Blue Cross Blue Shield Preferred Provider.

Dermatology Information and Resources

At the Alaska Center for Dermatology in Anchorage, we pride ourselves on being an excellent resource for dermatological knowledge, both medical and cosmetic. But we know that sometimes you need help that’s just a click away. Below are some of the best resources on the web concerning common issues related to dermatology.

American Academy of Dermatology
American Society for Dermatologic Surgery
The American Society for Mohs Surgery
National Alopecia Areata Foundation: Alopecia areata is an autoimmune skin disease that results in the loss of hair on the scalp and body.
Stevens Johnson Syndrome: Stevens Johnson Syndrome is a potentially deadly skin disease that usually results from a drug reaction.
Dystrophic Epidermolysis Bullosa Research Association of America: Dystrophic Epidermolysis Bullosa is a chronic disease that results in painful skin blistering.
National Foundation for Ectodermal Dysplasias: Ectodermal dysplasias affect the ectoderm, which is the outer layer of tissue in a developing baby.
National Eczema Association for Science and Education: Eczema is a very common skin inflammation characterized by excessive dryness and itching.
Foundation for Ichthyosis and Related Skin Types: Ichthyoses are genetic skin diseases characterized by dry, thickened, scaling skin.
Lupus Foundation of America: Lupus is an autoimmune disorder affecting the skin, joints, blood, and kidneys.
Mycosis Fungoides Foundation: Mycosis fungoides (also called cutaneousT-cell lymphoma) is a type of lymphoma that affects the skin.
International Pemphigus & Pemphigoid Foundation: Pemphigus and pemphigoid are autoimmune skin disorders.
National Psoriasis Foundation: Psoriasis is an immune-mediated disorder which may manifest itself on the skin or in the joints.
Scleroderma Foundation: Scleroderma is a chronic connective tissue disease.
Sjogren’s Syndrome Foundation: Sjogren’s Syndrome is a chronic disorder in which white blood cells attack moisture-producing glands in the eyes and mouth.
Sturge-Weber Foundation: This foundation seeks to improve the quality of life for those with Port Wine Stains, Sturge-Weber Syndrome, and Klippel-Trenaunay Syndrome. These conditions are commonly characterized by facial birthmarks, seizures, and glaucoma.
The Melanoma Research Foundation: Malignant melanoma is one of the three most common types of skin cancer and usually appears as a dark brown or black mole with uneven borders and irregular colors in shades of black, blue, red, or white.