Become a Client

For our new clients, many of our forms can be filled out online or fillable PDF and submitted securely to our Behavioral Health Clinic registration office in Anchorage at registration@apiai.org

You may also download the forms, print them out, and bring them to the APIA Main office location in Anchorage and direct them to: Attention APIA Behavioral Health Clinic– Registration  

NEW CLIENTS

Please download and complete the following forms prior to your first appointment:

• • New Client Registration Packet – Fillable PDF Forms
  • Consent for Telehealth
  • Acknowledgement of Receipt of Notice of Privacy Practices, Patient Rights and Responsibilities (HIPAA) Form

You will also need to EMAIL a photo or a scanned copy of your: 

• • Health Insurance Card
  • Identification Card
  • UPLOAD link for image of your insurance card and identification

Please review these forms prior to your first appointment. 

• • New Patient Letter
  • Notice of APIA Privacy Practices and Patient Rights and Responsibilities Form
  • Telehealth Information

CURRENT CLIENTS

For established clients, your provider may request these additional forms to be filled out or reviewed:

• • Annual Update Client Registration Form
  • BH-ROI rev. 12-20
  • Telehealth Information

PROVIDERS

If you are a medical/other provider, please make sure your clients are interested and aware of a referral to APIA Behavioral Health.  Please download and fill out a copy of the APIA BH Referral Form .  Please email it to registration@apiai.org or fax it to 907-222-4279.

• • BH-Referral-Form 2021

For State of Alaska referrals for children’s services, if the State of Alaska 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. 

• • APIA Release of Information (ROI) Form

PAYING FOR SERVICES AND INSURANCE INFORMATION

We accept Medicaid/ Medicare/ VA benefits and private insurance. Please bring a copy of your Insurance card to your initial appointment, any time there is a change in coverage, or you receive an updated card. 

If you do not have insurance, we will work with you to help determine your costs.  APIA offers self-pay pricing for Behavioral Health Services.  For those who may quality, APIA offers a APIA Behavioral Health Sliding Scale Application Form for self-pay uninsured or under insured clients. No one will be denied access to services due to inability to pay. There is a discounted/sliding fee schedule available based on family size and income. 

• • APIA Behavioral Health Service Fees
  • APIA Behavioral Health Sliding Scale Application Form

We offer Payment Plans as an easy way to pay balances off. If your account is more than $50, you may schedule automatic payments in monthly installments.  Payment plans are interest-free for up to 24-months and can be set up with one of our registration and scheduling technicians.  

• • APIA Payment Plan Form

If you have patients with questions or concerns about a bill you have received from APIA, you may contact the APIA behavioral health front desk or contact the APIA third-party billing service HRG directly.

1) HRG self-pay phone number is:  1-888-210-6493

2) HRG/APIA self-pay website is:     https://apiai.webview.com

VETERANS AFFAIRS SERVICES

We are blessed with safety and security at home because of the hard-fought sacrifice of so many men and women who have worn a uniform. APIA respects and supports veterans. APIA accepts Veterans Administration benefits to provide mental health services for all eligible veterans. These services include assessment, diagnosis, treatment and rehabilitation of mental disorders.