Transcription of OFFICE USE ONLY General Sample Submission Form VTH …
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OFFICE USE ONLY General Sample Submission Form VTH …
Print Form OFFICE USE only . General Opened By: Sample DHL USPS FX Courier Other Frozen Dry Ice Ice Pack RT Other Fixed Phone: 970-297-1281. Fax: 970-297-0320. Submission Sample Type(s): Comments: Form VTH USE only (Patient Card Here). FedEx/UPS/Drop Off Address: CSU Veterinary Diagnostic Laboratory 300 West Drake Road Fort Collins, CO 80526. USPS only Address: CSU Veterinary Diagnostic Laboratory 200 West Lake Street Clinician/Resident: _____. 1644 Campus Delivery Fort Collins, CO 80523-1644 Pager: _____ H-Account/Fund: _____. Veterinarian: Owner/Producer: Clinic: Business/Premise ID: Address: Address: City: State: Zip: City: State: Zip: Phone: Phone: Person to be Billed: Veterinarian Owner/Producer Report Results To: Veterinarian Owner/Producer Send Results By: Fax: Email: Phone: Avian (specify): Bovine Camelid Canine Caprine Equine Feline Ovine Porcine Reptile/Amphibian (specify): Wildlife/Exotic (specify): Other (specify): Specimen(s).
Separate submission forms are required for Clinical Pathology, Clinical Immunology and Necropsy.
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