Appointment Request

Please fill out this form in preparation for your visit to one of our SEARHC locations. If this is an emergency dial 911 or an Urgent/Emergent issue please go to Emergency Room or Urgent Care

Basic Information

SEARHC community location?

Have you been seen at SEARHC before?

Alaska Resident/Traveler Status

Preferred Appointment Date

Note: New Patient Appointments Are Preferred 2 Weeks In Advance

mm/dd/yyyy

Last Name

First Name

Middle Initial

City and State of Birth

Date of Birth

mm/dd/yyyy

Country

PO Box or Street Address

City

State, Zip code

Cell Phone

Phone

Work Phone

Phone

If none, write none@none.com

Upload Documents

Please upload a photo of your identification, Insurance Card, and 'Certificate of Indian Blood' if applicable. IF YOU ARE USING THE COVID TESTING OR URGENT CARE SITE IT IS VERY IMPORTANT TO UPLOAD THESE DOCUMENTS. Also please bring these documents to SEARHC for your appointment in person.

Drop your files here

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