IT Request Form

IT Request Form

Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.

Yakutat Community Health Center

PO Box 112

Yakutat, AK  99689

907-784-3275

907-784-3263 (fax)

This Health center receives HHS funding and has federal Public Health Service deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.  For more information, please see http://www.bphc.hrsa.gov/ftca/

For Life-Threatening Emergencies Call 911

This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.