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]
Client Registration fill-in form 06-07-1[...]
Microsoft Word document [113.6 KB]
Larry Moen, LPC
Where to Find Me
Uncommon Therapy
565 University Avenue
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
ONLINE SESSIONS AVAILABLE
Patient Forms
click on the button bekow for on-line forms
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