Pan American Vet Labs Sample Submission Form

PAN AMERICAN VET LABS BLOOD TEST SUBMISSION FORM

LAB USE ONLY
Submission #______
ACCT #______
Payment Received $______
Check #______

4735 County Road 309 www.pavlab.com

Lexington, TX 78947

TELE: 512 846 2140

*****SUBMITTOR INFORMATION REQUIRED*****

SUMITTED BY __VETERINARIAN __OWNER

OWNER NAME ______

CLINIC/FARM______

ADDRESS ______

CITY ______STATE_____ ZIP______

TELEPHONE______EMAIL______

3cc Blood or 1 cc serum required. Sample tubes must be clearly labeled with Sample Number AND Animal ID.

Please complete a separate form for each species
Species Number of Samples

Ovine ______

Caprine ______
Bovine ______
Equine ______
Canine ______
Other ______
If re testing Borderline samples enter submission number from original report
Submission #______/ Please check services desired.
1.  ______Ovine Progressive Pneumonia (OPP)
2.  ______Caprine Arthritis Encephalitis (CAE)
3.  ______Caseous Lymphadenitis (CL)
4.  ______Johne’s Disease (Paratuberculosis)
5.  ______Brucellosis
6.  ______Q Fever
7.  ______Toxoplasmosis
8.  ______Neospora
9.  ______Pythiosis
10.  ______Lagenidium
11.  ______Chagas disease (Trypanosoma cruzi)
Enter animal ID for each Sample Number Label tubes with Sample Number AND Animal ID
1.______5.______9.______
2.______6.______10.______
3.______7.______11.______
4.______8.______12.______
attach additional sheets for more samples