Veterinary Diagnostics

New Client Form

* = required field

Clinic name*

Mailing address*
(statements will be mailed to this address the first of each month for the previous month’s services.)

Address for sample pickup (if different)

Phone*

After hours phone
(so we can return calls at lunch, after closing, etc.)

Fax (reports will be sent by fax to this number)

Email*

Preference for results:

fax

both

Doctors’ names (first and last names please)

Doctor's Emails

Head Tech’s name (or other contact person)

Clinic hours

What motivates you to open an account with VDx? Please check all that apply
Quality
Service
Price
Recommendation by general practice colleague
Recommendation by specialist colleague
Personal experience with VDx at another practice
Molecular diagnostics(PARR testing, Flow Cytometry)
Dissatisfaction with another lab
Other(please type in comments box below)

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