Lymphedema Therapy of Alaska
Patient Intake Portal

Patient Intake Forms

Save time at your initial evaluation by downloading and completing these forms prior to your arrival.

Required Documentation

Comprehensive physiological screening is required for all new patients prior to our initial 90-minute decongestive evaluation. This ensures we have a full grasp of your surgical history and vascular health.

Clinical PDF Version 2026.04

Medical History & Intake

Download the unified clinical intake packet for Lymphedema, Oncology, and Post-Surgical patients.

Request Forms

How to receive your forms: Click Request Forms above to contact the clinic. We will send your intake packet via email prior to your appointment. Forms are also available in the clinic at your initial evaluation.

What to Prepare

  • List of all current medications.
  • Your surgeon's operative report (if applicable).
  • Primary physician contact information.
  • Recent imaging reports (Ultrasound, MRI, etc).

Privacy Policy

Your medical history is handled with strict HIPAA-compliance in our Anchorage facility.

Ready to accelerate your cellular healing?

Skip the trial-and-error. Reserve your comprehensive 90-minute evaluation with Jeana Kaufman to map out your intensive decongestive baseline.