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Registration. Services limited to Veterinary Practices in North Carolina.
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Indicates required field
Doctor Name
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First
Last
Email Address for Report Notification
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Additional Doctor Name 1
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First
Last
Additional Doctor Name 2
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First
Last
Clinic/Hospital Name
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Address Line 1
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Address Line 2
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City and Zip Code
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Additional Email Address for Report Notification
*
Email notification of completed reports can be sent to multiple addresses
Clinic Phone Number
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Alternative Phone Number
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Fax Notification
*
Yes
No
Clinic Fax Number
*
Login
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For access to the Telemedvet website. Consider making this generic for use by all doctors and staff. NO MORE THAN 15 CHARACTERS
Password
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at least 6 characters
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