Consent to Disclose Client Information to GVL

GlobalVetLINK (hereinafter “GVL”) is an Iowa, USA, limited-liability company, with its principal place of business at 2604 Northridge Parkway, Ames, IA 50010. Authorization is required or the disclosure of information, through its Web-based electronic equine infectious anemia system (Web-based eEIA System), by

• My accredited veterinarian; and

• The EIA approved laboratory

I hereby consent to, and authorize, the disclosure of my information (excluding financial) to GVL, as required for the submission of samples for EIA testing and production of EIA test certificates.

I hereby further consent to, and authorize, the access by the Canadian Food Inspection Agency (CFIA) to view my test results in the GVL Web-based eEIA System.

I hereby acknowledge and agree that, because GVL is a company resident of the United States of America, my test results and personal information may be accessible to the U.S. law enforcement and national security authorities pursuant to the USA Patriot Act, any other applicable legislation and, or any subpoena, administrative or court order.

By typing your name below, you are hereby giving consent to disclose your information to GlobalVetLINK (GVL).