SAMNet Signup Form for Veterans

Thank you for your interest in the SAMNet Vets program. Please complete this form and choose “submit” when you are done. After you have submitted your application, an email will be sent to the VIST professional listed on the form. The VIST professional should print out and sign the form contained in the email, and fax to Serotek within 30 days.

Are you a veteran with an existing Serotek account?

The user name that you enter below will be the basis of the veteran's email address. For example, if you enter "joe", then the veteran's email address will be "".

Note that the email address you enter below will be used to send important documentation which must be submitted for program eligibility.