Veterinary Clinic New Diagnostic Account Form Please sign up for an account with Hemopet’s Hemolife Diagnostics Laboratory.To order blood services, please call (714) 891-2022 Ext 1. Clinic Name Clinic General Email Address Street Address Street Address 2 City State/Province Country Phone Number Fax Number Primary Veterinarian First Name Primary Veterinarian Last Name Primary Veterinarian First Email 6 Canine NutriScan Kits Yes No 4 Canine / 2 Feline NutriScan Kits Yes No 6 Equine NutriScan Kits Yes No Please list additional vets at your clinic. Each one will recieve a personal login. Associate Veterinarian #1 First Name Associate Veterinarian #1 Last Name Associate Veterinarian #1 Email Associate Veterinarian #2 First Name Associate Veterinarian #2 Last Name Associate Veterinarian #2 Email Associate Veterinarian #3 First Name Associate Veterinarian #3 Last Name Associate Veterinarian #3 Email Associate Veterinarian #4 First Name Associate Veterinarian #4 Last Name Associate Veterinarian #4 Email Send Have Questions?Please feel free to contact us with any questions you may have. Contact