College of Veterinary Medicine

Veterinary Cardiac Genetics Lab

Complete a copy of this form for EACH DOG


  In addition to ONE COPY of this form FOR EACH DOG, complete ONE copy of the Payment Form
(Go to Payment Form)

Don’t forget to label the paper backing of each brush package (for cheek swabs) or each tube of blood (for blood samples) with the dog’s name.
OFFICE USE ONLY
A
B
C
D
 
 

Name    (person submitting samples)
Mailing Address
City  State   Zip Country
Dog 's Registered Name
Microchip Number (optional)
Dog Breed
Birthdate (m/d/y)
Gender male    male-neutered     female     female-neutered
AKC Number
I am requesting that the result's of my dog's genetic ARVC test be made available on the WSU web site at http://www.vetmed.wsu.edu/deptsVCGL/Boxer/TestResults.aspx only if negative for the mutation    if results are positive or negative  do not post  
Signature of dog owner

Date of Signature

Send the labeled brushes or tubes of blood, completed information forms and payment to:   
 
Sent via US Postal Service

Veterinary Cardiac Genetic Laboratory (VCGL)
Washington State University
Post Office Box 605
Pullman, WA 99163-0605

 Sent via Federal Express or Other Carriers

Veterinary Cardiac Genetics Laboratory
Washington State University
Attn: Dr. Kathryn Meurs
100 Grimes Way
Pullman, WA 99164-7060

  Email VCGL@vetmed.wsu.edu

Phone: 509-335-6038

 


Last Edited: May 12, 2009 3:52 PM
Veterinary Cardiac Genetics Lab, PO Box 605 , Washington State University, Pullman WA 99163-0605, 509.335.6038, Contact Us   Safety Links