New Client Form - Wisconsin Veterinary Diagnostic Laboratory

New Client Information

You can expect an email with instructions for access to our Client Portal within 3 business days of submission of this form. If you have questions or do not receive instructions, please contact billing@wvdl.wisc.edu. You may submit samples without Client Portal Access.

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Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.

Clinic Information(Required)

Full Clinic name

Clinic Address

Street Address Address Line 2 City State ZIP Code

Clinic Phone number(Required)

Clinic Email Address – Invoices(Required)

Clinic Email Address – Test Results(Required)

Clinic Test Results FAX number (Optional)

Please email billing@wvdl.wisc.edu if you would like results sent to Fax automatically.

Additional reporting emails/portal accounts

Each doctor may have their own email in addition to the clinic email for result reporting. We will send a portal invite to every email listed here.

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Laura Zitur

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