Patient Referral Forms


We are pleased that you chose Alaska Sleep Clinic, and we are looking forward to helping your patients get the services and treatment they need to get their sleep health back on track.  Alaska Sleep Clinic is here to make your job easier and your patient's sleep better.

Referring Your Patients to ASC

Web-Fillable Referral Form 
Download Referral Form


Please send medical history, medication list, insurance information and a copy of insurance card (front and back).


Anchorage Fax: 907-770-8965     Fairbanks Fax: 907-374-8872     Soldotna Fax: 907-420-0541     Wasilla  Fax: 907-357-6672