HMBMDC Histiocytic Clinic
Preregistration
Name
*
First Name
Last Name
Email - please use the same email associated with your Antagene account.
*
example@example.com
Example layout of question below
1. “Moe” - Registration Name- identification number 2. “Bernie”-Registration Name- identification number
Dog(s) being tested: please list dog(s) call name, registration name, and identification number.
*
I understand that I have to purchase the histiocytic sarcoma test on Antagene prior to clinic and the clinic fee does not cover the cost of the test itself.
*
Yes
No
When is your preferred blood draw time?
Friday, Sept 27th, during clinic
Friday, Sept 27th, outside of clinic time
Saturday, Sept 28th
Sunday, Sept 29th
Unsure of best time
Checklist
Thank you for doing preregistration for the HMBMDC Histio clinic! We appreciate your support for the betterment of our breed.
Clinic fee will be collected at the clinic. Please complete checklist above prior to attending. We will reach out to your email above to confirm registration, send you clinic information, and more. If you have any questions or concerns please contact Hunter Calvelage at carmaque@yahoo.com or at 419-204-7773. We are looking forward to your attendance!
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