Laboratory Certificate Upload Form

Please complete the form below to submit laboratory certificates. For additional information, please email HANC.

First name * [* = required]

Last name * [* = required]

Email address * [* = required]

Institution * [* = required]

Lab Type * [* = required]

If selected "Other", please provide more information [* = required]

Certificate Type * [* = required]

CAP

CLIA

Certificate Exemption

ISO 15189

ISO 15190

SANAS

Other

If selected "Other", please provide more information. [* = required]

Effective Date * [* = required]

Expiration Date * [* = required]

Submit Certificate PDF *

[* = required]