Form

Company name

Street address

City

State/Region

Postal code

Primary Email Address*

Phone number

First name

Last name

Primary contact email*

Beginning Teleradiology Services

Yes! I’d like to begin using the service now

No, please contact me first. I have questions not answered in this message.

DVMinsight Request to Transfer Account*

Yes, I have a DVM Insights Account, and I would like to have it transferred to IVPA

The individual submitting this form to IVPA has the authority to request the transfer of their account from the current provide to IVPA (Independent Veterinary Practitioners Association)

Certification of Authority to Request Account Transfer *

Name of current teleradiology service company:

NOTE: If you are currently using Veterinary Imaging Consultations, Snake River Imaging Consultations, Axam Imaging, Online Veterinary Image Consultants, or Shadow Lake Radiology, please note that IVPA radiologists are already reading your cases, and we encourage you to reconsider switching.

List of current Doctors and Email Addresses

Comments or questions?