SMS Letter of Authorization (LOA)
MedReceptionist · Hosted Number Messaging
1
Practice information
exactly as it appears on your telephone bill| Business name | |
|---|---|
| Authorized contact name | |
| Contact title (optional) | |
| Contact phone number | |
| Contact email |
2
Service address on file with your current carrier
physical location — no PO Box| Street |
|---|
| City | State | Postal code |
|---|---|---|
3
Phone number(s) to SMS-enable
| Phone number |
|---|
A Service Provider Identifier (SPID) specifies where messages are routed in US/CA. MedReceptionist manages SPID assignment for you.
4
Recent phone bill (recommended)
carriers may request proof of ownership — attaching it now avoids delaysPDF or photo of the most recent bill for the number(s) above · max 3.5 MB
By signing below, you verify that you are the above-named customer and at least 18 years of age.
The name and address you have provided is the name and address on record with your local telephone
company for each Phone Number listed above. You verify that you are (or you have the authority to
represent) the Phone Number owner. You represent and warrant that you have the authority to use and
manage the listed Phone Numbers without the consent of any third party. You authorize Twilio Inc. and
its representatives — acting as messaging provider for MedReceptionist (AI Scan Solutions LLC) — to act
as your agent to enable messaging and related services (the “Services”) for the Phone Numbers,
including taking any appropriate action to provide the Services, making the carrier change(s), for
example, an inventory of phone lines billed to the Phone Number(s), carrier or customer identifying
information, and billing addresses.
Sign with mouse or finger, then submit — we handle the rest with Twilio. Electronic signatures are accepted.