Biopsy Submission Form – Keystone Veterinary Pathology

This form is used for submitting biopsies

It must be sent at the same time the biopsy is mailed or results will be delayed
Biopsy containers must be clearly labeled with the clinic, owner, and patient names.

You can also use the PDF form which can be filled out and faxed to us at 814-254-4649: Download Form

Contact Info

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)