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Welcome Provider
Portal Create Account

Step 1 of 3

To create an account with SOLVD Health, please fill out this form. Once our team verifies your account information, we will ship you 5 collection kits to get you started with LifeKit™ PreScript.
Step 1: Contact Information
Please enter the contact information for the primary point of contact on your account. Required fields are marked with a *
Contact Person’s Name*
First Last
Contact Phone*
Contact Email*

Step 2: Location Information
Please enter your location details. This address is where we will send your collection kits. Please be sure to provide the NPI number. Required fields are marked with a *
Practice/Hospital Name*
Phone*
Fax
Address*
Street Address Address Line 2 City State ZIP Code
NPI#*

Step 3: Administrators/Providers
Please enter information for your location’s providers and account administrators. NPI number is required for providers. Required fields are marked with a *
Name*
First Last
Email*
Access Level*
NPI#*
Add Additional Administrator/Provider
Add more?
Name*
First Last
Email*
Access Level*
NPI#*
Name*
First Last
Email*
Access Level*
NPI#*
Name*
First Last
Email*
Access Level*
NPI#*

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