Complete the form below to request an ECI® tumor collection kit.

Please allow 5 business days to receive a kit when using this form. If you have previously completed ECI® training and have an urgent kit request, please contact your ELIAS Concierge contact via phone or email.

If your hospital/clinic is not yet an ECI® Authorized Treatment Center, please contact us to schedule training before your request can be fulfilled.

Name of requesting veterinarian: *

First

Last

Name of person submitting this request: *

First

Last

of veterinarian: you

Email: *

Hospital/Clinic Name: *

Hospital/Clinic Phone: *

Hospital/Clinic Address *

Address Line 1

Address Line 2

City

State

Zip Code

Hospital/Clinic Website *

Confirm you are placing this request on behalf of a veterinary hospital/clinic. *

Yes, I am a representative of the hospital/clinic listed above.

This form is intended for ECI® Authorized Treatment Centers (ATC) to request tumor collection kits. If you would like to become an ATC, please contact us here.

Complete the form below to request an ECI® tumor collection kit.

This form is intended for ECI® Authorized Treatment Centers (ATC) to request tumor collection kits.
If you would like to become an ATC, please contact us here.