Hb Variant Case Submissions

Case Submission Form

Instructions

Only one case submission per form. Multiple cases must be submitted seperately. Number of submissions per person are not limited.
Text or images may be attached with your submission. The maximum upload size per file is 50MB. Up to 15 attachments are allowed per form. The following file formats are only accepted: PDF, DOC, DOCX, TXT, JPG, PNG, GIF, XLS, XLSX.
All submissions that are approved and uploaded become legal property of Bio-Rad Laboratories.

Contact Information

First Name *This question is required.

Last Name *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number

Job Title *This question is required.

Department

Institution *This question is required.

Street

City *This question is required.

Country *This question is required.

Postal Code

State