New Patient Paperwork
New Patient Supplemental
Consent to Treat Minor Form
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 SIGNED in the presence of Cornerstone Medical Clinic employee unless it is notarized.
Release of Information Forms:
From Cornerstone Medical Clinic
To Cornerstone Medical Clinic
PLEASE NOTE: Once received, your request will be processed and may take up to 30 business days. The records can be mailed, faxed, or picked up from the clinic--please mark your preference on the form. Due to high volume and time-consuming nature of requests, Cornerstone Medical Clinic has implemented charges for Medical Records. Please contact our office for more information. Cornerstone Medical Clinic will not charge a fee for processing requests for releases to medical insurance companies or for Workers' Compensation. If you are discharged from Cornerstone Medical Clinic, your records may be provided to you on a one time basis at no cost.
Transparency Law (please click here)
Holidays and Observances
Please note that the clinic will be closed for the following holidays and observances:
New Year's Day, January 1 (Wednesday)
Memorial Day, May 25 (Monday)
Independence Day, July 3(Friday) Observed
Labor Day, September 7 (Monday)
Thanksgiving Day, November 26 (Thursday)
Christmas Day, December 25 (Friday)
Discrimination is Against the Law
Cornerstone Clinic Medical Center complies with applicable Federal Civil Rights Laws and does not discriminate nor exclude people or treat them differently on the basis of race, color, national origin, age, disability, or sexual orientation.
Cornerstone Clinic Medical Center:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
Written information in other formats (large print and accessible electronic formats)
If you believe that Cornerstone Clinic Medical Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sexual orientation, you can file a grievance with:
David Frain, Practice Manager
1825 Academy Drive
Anchorage AK 99507
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, David Frain is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at:
or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
1825 Academy Dr.
Anchorage, AK 99507
Phone: (907) 522-7090
Fax: (907) 522-7095
Monday: 8am – 4:00pm
Tuesday: 8am – 4:00pm
Wednesday: 9:30am – 4:00pm
Thursday: 8am – 4:00pm
Friday: 8am – 4:00pm
1825 Academy Dr.
Anchorage, AK 99507
Phone: (907) 522-7080
Fax: (907) 522-7088
Monday: 9am – 6:30pm
Tuesday: 9am – 6:30pm
Wednesday: 9:30am – 6:30pm
Thursday: 9am – 6:30pm
Friday: 9:30am – 5:00pm
IF THIS IS AN EMERGENCY CALL 911 IMMEDIATELY
For non-emergency, non-medical questions or comments feel free to email us below.
If you have a question regarding your medical care, prescriptions, appointments, etc., please call our office. Please allow for up to a 24-hour response time when sending us an email from this address.
Please note that this page is not secure and is not intended to convey sensitive information.