DRAFT IN PROGRESS

Alchemed Lancet Details: As part of our project to facilitate the integration of your practice with Lancet, we need you to to provide certain information and preferneces. Please complete the form below and then [        ].

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Practice Name *

Please select Clinician

Practice Number *

Clinician Name *

First

Last

Email *

Clinician Lancet Number *

Please select to indicate your Lancet preferences *

• Integration = Results fed automatically into your patient file
• Integration & Email = Results fed automatically into your patient file + email received with results
• Integration & Hand Delivery = Results fed automatically into your patient file plus Hand delivery of results

Comment or Message *

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