Uncommon Therapy
Uncommon Therapy

Enrollment Form

When you have been accepted for a chronic insomnia treatment group, please fill do the following:

  • click on the icon for the form below
  • save a copy of the form by using the SAVE AS command
  • tab through the form to fill it out
  • email your completed copy of the form to Uncommon.alaska@gmail.com

 

treatment enrollment form
Client Registration fill-in form 06-07-1[...]
Microsoft Word document [113.6 KB]

Larry Moen, LPC

Where to Find Me

Uncommon Therapy

315 Cindy Drive

Fairbanks, AK 99701 

 

APPOINTMENTS:

(907) 459-8200

Office: (907) 374-8777

Text: (907) 388-8963 (best method)

Email: uncommon.alaska@gmail.com

 

 

Or use our contact form.

Office Hours

Monday - Friday 9 AM - 6 PM

Saturday and other hours by arrangement

SKYPE SESSIONS AVAILABLE

Patient Forms

click on the button bekow for on-line forms

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