Patient Forms:

Our receptionist will let you know which of the forms below you will need to complete before your visit. 
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Please print out or download requested forms and bring to your scheduled appointment or email completed forms at

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• Medical History

• Child - Review of Systems

• Adult - Review of Systems

• Demographic & Billing Information

• Financial Policy

• HIPAA Acknowledgement

• HIPAA Omnibus

• Release of Information (ROI)

• Telemedicine Consent Form

• Private Medicare Contract (each provider is a different entity):

      - Contract for Dr. Trujillo

      - Contract for Dr. deSchweinitz

      - Contract for Candace Carson-McCollum, FNP

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Insurance: 

We accept nearly all major insurance plans including:

Since this list can change at any time, please contact your insurance plan to confirm they contract with our office for services you need.​​

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• Blue Cross Blue Shield

• Cigna

• Aetna

• United Healthcare

• Alaska Laborers

• ASEA

• EBMS

• GEHA

• Teamsters of Alaska

• Public Employees Local 71

• MODA Health

• IBEW Local 1547/Alaska Electrical Trust​

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Our office has opted out of Medicare, but we can offer a Private Medicare Contract and self - pay rates.

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Please call for more details.

Medical Records:

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• Please fax ROI to 569-3200

• If you have any additional questions please call the office.

• There may be additional fees

• Please allow 2-30 business days for processing.

Additional Fees: 

There may be an additional fee for completion of forms for use outside of the patient's medical record, including:

• DOT Paperwork

• Pre-Employment

• Employment

• Life Insurance

• Family Medical Leave (FMLA)

• Medical Records

• Daycare