DOGS TEST REQUEST FORM

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  Instructions:
- Fill out the form in all its parts
- After filling out the form complete with all its data, press SEND at the bottom of the page before printing.
- At this point, the form must be:
1. Printed
2. Stamped
3. Signed by the VETERINARY
4. Signed by the OWNER
5. Posted attached to the sample and to the copy of payment.
- The report is mailed to the owner
INFORMATIONS
TEST(S) REQUESTED
DNA sample storage
Parentage determination *
Genetic Identification *

EBJ*   (only EDTA blood sample)
Cystinuria (Newfoundland breed, Bulldog, Labrador) *
VWD1 (Dobermann, Pinscher)
EMOFILIA B (Rhodesian Ridgeback)
Caryo test

*The price is inclusive of DNA sample storage.
PRICE

€ 0,00 Total

   Date of sampling
   City
   Veterinary name
   Note
Information: "Part of the services, under the responsibility of Vetogene Srl, may be entrusted to external testing laboratories that have successfully passed the CT-CG ISAG and / or meeting the requirements
ISO 9001 or ISO 17025 in force. "
"THE TIMES OF TEST RESULTS ARE SUBJECT DELAYS FOR TECHNICAL PROBLEMS RELATED TO THE TYPE AND STORAGE OF BLOOD - RECEIVED DNA "
OWNER INFORMATIONS
Name
Adress
City / Province
Postal code / Country
Phone
E-mail
 
INVOICE DATA  (REQUEST )
Name
Adress
 



Consent to the processing of personal data   (required)
By sending this form I consent to the processing of data for the request in accordance with our privacy policy (mandatory acceptance). Explicit consent according to the GDPR, General Data Protection Regulation - EU Regulation 2016/679.
DOG IDENTIFICATION
Registered Name
Breed
Sex
Birthdate
Mantle
Registration number
Tattoo
Chip


* required tattoo or chip
FAMILY DOG INFORMATIONS
Registered name of Sire
Registered number of Sire
Registered name of Dam
Registered number of Dam