Individual/Patient Account Registration

Individual/Patient accounts are meant for those who are interested in evaluating/monitoring their own health status, and for patients who have been referred to VCSTest.com by their healthcare provider.   If you are either an individual or a patient, please fill out and submit the registration form below.  Fields outlined in red are required.

If you're a healthcare provider and plan to or may use our test with patients or clients, please do not register as an Individual/Patient using this form; instead, please register using our Healthcare Provider Registration Form.

If you're a researcher associated with a university or organization with a history of publishing bonafide medical research and plan to (or may) use VCSTest.com in your research, you may qualify for free use.  Please register using our Research Registration Form.
Required Information
  
  
  
  
Choose Account Type:  


Optional Information
Optional information will be used for greetings, to identify your results, and for research purposes, and will not be shared or used otherwise.
Practice/Organization Information
Please provide the following practice/organization information.
Organization Information
Please provide the following information for the organization conducting the research.
  
  
  
  
  
  
  
  
  
  
  
Practitioner Information
Please provide the below information for the practitioner who will be using the test.  If your organization has multiple practitioners and you'd like to have them listed as referrers individually, please contact us after registering.
Researcher Information
Please provide the following information for the researcher who is primarily responsible for the research or for using VCSTest.com.
  
  
  
  
  
Research Information
Referring Healthcare Provider
If you were referred to the site by your healthcare provider and would like to share your test results with them, please choose their name from the dropdown list (you can search the list by typing after you've clicked the dropdown):
  
If your referrer isn't listed here, please let us know so we can contact them and add them to the list.

(Note:  If you are a healthcare provider and would like to be listed here so you can receive patient test results directly from VCSTest.com, please register using our Healthcare Provider Registration Form.)
Verify
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