Information for Providers

LifespanLink Request

Thank you for contacting the LifespanLink Request Team. If you are having difficulties with this form, please contact us at 401-606-5465, during our normal business hours, Monday through Friday, 7 a.m. to 5 p.m.

Download your LifespanLink QuickStart Guide

Request Form

Type of Request

First File Upload

One file only.
512 MB limit.
Allowed types: rtf, csv.

Second File Upload (if needed)

One file only.
512 MB limit.
Allowed types: rtf, csv.

Third File Upload (if needed)

One file only.
512 MB limit.
Allowed types: rtf, csv.

LifespanLink ID of Blocked User

Requestor's Information

Requestor's First Name

Requestor's Last Name

Practice Name/Study Name

Phone Number

Email Address

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