Click on the tabs to the left to submit biopsies or order supplies
SUBMIT BIOPSIES
Download PDF
Date
Referring Veterinarian
Clinic
Street Address
City
State
Zip Code
Phone/Fax
Email Address
Owner’s Name
Patient’s Name
Age
Sex MMNFFS
Species
Breed
Color
If Euthanized, what route? (optional)
Previous Keystone Vet Path Case Number:
Case History
Tissue Submitted (Also indicate number of tissues enclosed)
Shape/Color
Specimen Size (centimeters, 3 dimensions)
cm
Other gross features of tissue (hard, soft, fluid-filled, cystic, gritty, ulcerated, freely movable, fixed, etc).
Clinical Diagnosis
Location of Lesion (if multiple lesions found, please indicate which are included as tissue samples)
ORDER SUPPLIES
Supplies Available
Charge per item
Number requested
60 ml formalin filled jars
$2.25
120 ml formalin filled jars
$2.50
Small cardboard box
No charge
Large cardboard box
Small postage paid mailer
$7.00
Large postage paid mailer
$8.00
* A single zip-lock submission bag with pouch for paperwork is included with each formalin filled container * The number of supplies requested will be limited to the those that fit in one shipping box unless otherwise specified * The cost of shipping supplies will be added to each order
Clinic Name (required)
Your Email (required)
Street Address (required)
City (required)
State (required)
Zip Code (required)
