College of Veterinary Medicine

Veterinary Cardiac Genetics Lab

Complete a copy of this form for EACH CAT


  In addition to ONE COPY of this form FOR EACH CAT, 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 cat’s name.
OFFICE USE ONLY
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Name    (person submitting samples)
Mailing Address
City  State   Zip Country
Cat Name
Microchip Number (optional)
Cat Breed
Birthdate (m/d/y)
Gender male    male-neutered    female    female-neutered
Name of Veterinarian
I verified this cat’s identity by this Microchip or Tattoo

Printed Name of Veterinary Professional

Signature of Veterinary Professional
DNA Mutation Test Predominately for: Maine Coon Cats         Ragdoll Cats       Both Tests
The following information is OPTIONAL, We ask because it may help us learn more about this disease in the future.

Date of Last Echocardiogram:     Normal     Equivocal     Diagnosed with HCM

Please tell us if this cat is a direct relative to a cat with Hypertrophic Cardiomyopathy AND/OR a cat that has been tested for this mutation and  describe the relationship
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: Aug 01, 2007 9:12 AM
Veterinary Cardiac Genetics Lab, PO Box 605 , Washington State University, Pullman WA 99163-0605, 509.335.6038, Contact Us   Safety Links