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, 7:30 a.m. to 6 p.m.

If you are sending files, please note that we are not able to accept PDF, Excel or Word documents through this form.

For Word documents, please save the file as a .rtf or .txt file before uploading.
For Excel spreadsheets, please save the file as a .csv document before uploading.

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