EMR Integration Request

Solaris Diagnostics has the capability of integrating with your Electronic Medical Records (EMR) system. Please complete the form below to receive more information.

Clinic / Client Full Name

EMR Service Provider

EMR Integration Type

Has the EMR Service Provider been contacted?

EMR Service Provider Contact First Name

EMR Service Provider Contact Last Name

EMR Service Provider Contact Phone

EMR Service Provider Contact Email

EMR Account Number

Main Account Username:

Account Holder Name:

Authorizing Name