LaTouche Pediatrics, LLC - Anchorage, Alaska: Forms

New Patient?

Please complete the following forms and bring to your first appointment.

Release of Information to LaTouche Pediatrics
Use this form to have records from your previous provider sent to LaTouche Pediatrics.

Already a Patient?
You can update your information online using the Online Forms or by filling out the forms below and bring it to your next visit.

Consent and Authorization for Treatment of a Minor

Release of Information from LaTouche Pediatrics
Please use this form if you need records from our office transfered to another person/practice.

Expecting a Baby?

Choosing a Pediatrician

Prenatal History Form
Please fill out this form, and bring it with you to your Prenatal Appointment with the Physician of your choice. If you prefer, when you call to arrange for your baby to become our patient, we can mail you the form.

Online Patient Forms

Forms Available for Download
Online Patient Information Form
Online Appointment Request
Online Prescription Refill
Online Immunization Records Request
Parent Profile