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HISTO/CYTOLOGY REQUEST FORM

2022 IDEXX Laboratories, Inc. All rights reserved. 2012020-0122-UKIDEXX Reference LaboratoriesHISTO/ cytology REQUEST FORMHISTOLOGY / cytology PROFILESBMEXBone Marrow CytologyHICLH istology & Culture & SensitivitySWCYC ytology & Culture & SensitivityHISMH istology & cytology on SmearsHISKH istology & Complete Skin ExaminationHICYH istology & cytology on FluidsTissues to be submitted in 10% Neutral Buffered Formalin. Polypropylene tubes with fixative are available from the laboratory. Please do not push large tissues into small pots. Please ensure absorbent material is included in order to contain any leakage in handles personal data responsibly and has adopted the privacy policy which can be found at ID / PIMS NUMBER OWNER S NAMENAME OF ANIMALSPECIESAGEBREEDSEXNEUTERED ENTIRELAB NUMBER (LAB USE ONLY)VET CODEDATEVETERINARY SURGEONADDRESS STAMPFOR LAB USE ONLYEDTA FLUIDHISTOLOGYPLAIN URINEGTDPLAIN FLUIDSKIN SCRAPEBORIC URINEREVEDTA URINESKIN SLIDEUNLABELLEDNHSFIXED FLUIDEDTA WHOLE BLOODLOCK BOXFRESH TISSUESMEARCOURIERHISTOLOGY UHIS FastTrack Histology Samples received Monday to Thursday.

SWCY Cytology & Culture & Sensitivity HISM Histology & Cytology on Smears HISK Histology & Complete Skin Examination HICY Histology & Cytology on Fluids Tissues to be submitted in 10% Neutral Buffered Formalin. Polypropylene tubes with fixative are available from the laboratory. Please do not push large tissues into small pots.

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