Fullscript x Elation Authorization and Consent and BAA Form

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THIS FORM IS NO LONGER IN USE - To get your Elation + Fullscript integration activated, please log into your Fullscript account here. If you do not have a Fullscript account, you can create your free account here.

Full name: *

Email associated with your Fullscript account. Don't have a Fullscript account? Click here to create your free account and return back to this page to complete your form. *

Elation Practice Name: If you don't know what your practice name with Elation is, please refer to this guide article.
*

Email associated with your Elation account: *

Best contact number *

Number of providers in your practice:

Number of patients you serve:

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