New Client Form

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 You may submit samples without Client Portal Access.


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 ( Important: Delete this tip before you publish the form.
Clinic Information(Required)
Clinic Address
Please email if you would like results sent to Fax automatically.
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.