signup

This information will update the database to provide clients with better service.
All information is kept confidential to Iowa State University Veterinary Diagnostic Laboratory.

Note: all * denote required fields

I am registering as*

Name


Firstname*	Middle Initial	Lastname/Clinic name*


Email*		Preferred report type*

If Fax, Email or Web report type is chosen, acknowledgements for receipt of samples, reports and test results will be sent by the method selected. Postcards will no longer be mailed.

Username and password


Username*	Password*	Confirm Password*

Business address


Address 1*		Phone 1
		- -
Address 2		Phone 2
		- -
Address 3		Fax*
		- -
City	State	Zip

Clients who request the invoice sent to a different address should complete the information requested below. Home addresses for Veterinarians are suggested for prompt notification of rabies test results and for emergencies.

Home address (OPTIONAL)


Address 1		Phone 1
		- -
Address 2		Phone 2
		- -
Address 3		Fax
		- -
City	State	Zip

Clients: Please list, in the Comments area, all veterinarians submitting cases for you.
Veterinarians: Please list, in the Comments area, any clients/clinics for whom you will submit cases.

Comments