referral forms

For your convenience, please print and use this referral form when referring a patient. Please mail or fax the completed form to Dr. Schlansker. Thank you for your referral. Dr. Schlansker will keep you advised about the progress of treatment.

Dr. William Schlansker
1600 E. Tudor Rd.
Anchorage, AK 99507
Phone: 907.561.1228
Fax: 907.563.8654

Referral Form

Letter of Medical Necessity

Forms are in Adobe Acrobat pdf format.  If you do not have the Acrobat Reader installed, you can download the free reader here.