I hereby certify and attest, by my signature, that all the information above is true and accurate. I understand that any information provided pursuant to this Attestation that is subsequently found to be untrue and/or incorrect could result in my termination from the Lucet network. 

Furthermore, I have read the Lucet Provider and Facility Manual and supplemental Telehealth materials on the Lucet website and understand the requirements for delivery of Telehealth services.  I understand it is my responsibility to comply with all Lucet requirements and state and federal Telehealth statutes, regulations, and guidelines.  I will cooperate with 

In all other respects, the terms and provisions of the Agreement shall remain the same.