LabOnline Registration for Clinical Testing
This form is intended for healthcare-related facilities and their employees. LabOnline allows the user to electronically request testing and access results for patients under their care.

For LabOnline access for animal testing, use the Zoonotic LabOnline Request form:

To make a change or update to an already existing LabOnline account, use the Customer Account Update Request form

Note, please complete this form using your work-affiliated email address.
Personal email addresses will undergo additional verification from their employer.
Upon completion of this form, you will receive a link to e-sign the LabOnline Terms of Use Agreement.  
You will not be granted an account until we receive the signed agreement.

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Email *
Which status best describes your request? *
First name *
Your first name.
Last name *
Your last name.
Phone *
Your 10-digit work-affiliated phone number.  Numbers only.
Account type *
Captionless Image
Facility *
The name of your facility or organization.
Street address *
The street address of your facility or organization.
City *
The city of your facility or organization.
ZIP code *
The ZIP code of your facility or organization.
Supervisor *
Person of contact at your facility to verify your employment.
Requested clinical tests *
Additional comments
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