We are asking you to complete our Patient Questionnaire to enable our clinical and administrative staff to prepare for your visit and to make your check-in for your appointment quicker and easier.
To start, please click the Start button below.
To complete a document, simply fill out the fields with the requested information. Fields marked by asterisks must be completed. When you have completed a document please review your entry, click the Submit button to move to the next document. Please don't use your browser's Back or Forward buttons. Use of these buttons may 'undo'/'redo' your recent actions and may result in errors.
Please note that the information you will submit will be encrypted for your protection and goes directly to our office. We appreciate the time that you will spend providing the information helping us prepare for your visit.
Please call our office (907) 562-6456 or email Office@AnchorageMidtownDental.com if you have any questions.