Phone:  (907) 569-1333
Fax:  (907) 569-1433

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Phone Message Consent Form

, , acknowledge and agree that (Alaska Digestive and Liver Disease) and any affiliates or vendor thereof, including collection or billing companies, may contact me by email, telephone or text message to any telephonic number or email address I have provided to you, and any other telephone number associated with my account, including wireless or mobile telephone numbers. I further agree that you may use any method of contact to these numbers, such as an Automated Telephone Dialing System (ATDS) or prerecorded message. I also agree that I will notify (Alaska Digestive and Liver Disease) if I have given up ownership or control of any such telephone number.


By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.