This information is for internal use by Lumistry only and won't be displayed on your patient education page.
This information will be displayed for patients on your patient education page.
Theme Color *
This is the color of your whitelabeled website, including buttons and any other webpage characteristics. You can customize elements to your brand color or use the default Lumistry Blue. (If you need help extracting a HEX value from your logo, a tool like this can help!)
Let us know how you plan to pay here. Please note that we will not ask for specifics on this form; more details will be requested via email based on your selection.
By clicking below and submitting this form, you acknowledge: 1) you are familiar with your state’s requirements for providing patient medication information; and 2) you have reviewed the startup information and agreed to subscribe to Lumistry's Paperless Patient Education per the terms and conditions found at lumistry.com/client/terms-conditions and the subscription fee.