Initial Intake Documents - Set Free Alaska - Alcohol and Drug Treatment Alaska

Intake Document Upload Form

You are almost finished! The next step is to upload photos of the following items.

Which Location Are You Applying To?(Required)

Mat-Su Location

Homer Location

Upload a photo of the front of a valid ID(Required)

Drop files here or

Accepted file types: jpg, pdf, png, Max. file size: 50 MB, Max. files: 2.

Upload a photo of the front and back of insurance card

Drop files here or

Accepted file types: jpg, pdf, png, Max. file size: 50 MB, Max. files: 2.

Appling for sliding scale? Must provide 2 most recent pay stubs or last year's tax information.

Drop files here or

Accepted file types: jpg, pdf, png, Max. file size: 50 MB, Max. files: 3.