IDEXX BIOANALYTICS

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City:

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Country:

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Phone Number:

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Non-Disclosure Agreement

I agree that access will be granted to the BioAnalytics Database system with the understanding that I am responsible for all activities undertaken using my UserID access code and other forms of authorization. *

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I need access to cases submitted under my name:

AND/OR

I need access to cases submitter under another name(s):

If "another name(s)" is checked, please provide name(s) and contact information so that authorization may be verified.

I authorize on-line access to cases submitted under my name to the following person(s). I understand that these individuals will need to apply for their own UserIDs.

Tell us how you heard about IDEXX BioAnalytics:

Other:

Request for Client Access / UserID