Patient Forms
Print the form you need, fill it out, and bring it with you to the clinic.
Troy Medical forms
Download, print and complete. Please do not email completed forms; bring them to the clinic.
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Authorization for Release of Medical Information
Use this form to have your records sent to, or requested from, another provider or person.
Download PDF -
Cancellation / No Show Policy
Please cancel or reschedule at least 24 hours before your appointment. Effective April 1, 2026.
Download PDF -
Hardship Form
Financial Hardship Waiver Request. Ask for a full or partial reduction of your balance if paying it would be a financial hardship. All information is confidential.
Download PDF
Forms from other organizations
These forms belong to other agencies. The links open their official website so you always get the current version.
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Fairbanks North Star Borough
Van Tran Application
Paratransit service in the Fairbanks North Star Borough. Complete your part and bring it to the clinic; your provider completes and signs the provider section.
Open on Fairbanks North Star Borough website -
Alaska DMV
Disabled Parking Permit Application
Alaska DMV form 861. Complete your part and bring it to the clinic; your provider completes and signs the provider section.
Open on Alaska DMV website
Referring a patient? Use the referral form. Questions about a form? Call us at (907) 268-2737.