FAVN Submission Form

Clinic Information

× Please enter your client number, phone number and email address associated with that account.
If you do not know your client number, visit Client Account Lookup.
If you need to request a client number, visit Register New Client.
If you need more assistance please contact the VMDL at 1-800-862-8635.

Client Account Number *

Email *

Phone *

Submitting Clinic *

Clinic Mailing Address *

City *

State *

Zipcode *

Country *

Submitting Veterinarian

Veterinarian Name *

Fax

Owner Information

Owner Name *

Owner Phone

Owner Email

Owner Address

City

State

Zipcode

Animal Information

Animal Name *

Microchip Name *

Serum Draw Date *

Species *

Breed

Sex

Date of Birth

Animal Export Destination *

Rabies Vaccination History

* I understand a veterinarian signature is required on the printed copy that will be sent with the sample.

* Please double check the information entered. Verify the microchip number is correct and that it matches the microchip number of the tube label. Corrections require documentation and will incur extra costs.