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Download INDIVIDUAL ANIMAL SUBMISSION FORM (A)
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M D S Molecular Diagnostic Services, Inc. Phone: (858) 450-9990; Fax: (858) 450- 0619; E-mail: [email protected] Tissue Cross Reactivity (TCR) of a Monoclonal Antibody (X) Please print and complete this form and forward/fax to MDS. We will contact you for a detailed quotation. Institution: Email: Billing Address: Submitted by: Shipping Address: Zip: Fax:( ) - Investigator: Date Submitted: State: Phone:( ) / / PO #: City: Ext: - A: Sources of Antibody Full name of Antibody Manufacturer Volume provided , Concentration mg Recommended storage Temp. /mL Preservative if applicable B: Tissue selection: Indicate (check box) Normal Tissues to be included in IHC Testing Central Nervous System: Brain, Cerebrum Cerebral Cortex Brain, Cerebellum Spinal cord Peripheral Nerve (Optional) Glands : Adrenal Ovary Pancreas Parathyroid Pituitary (Optional) Thymus Prostate Testis Thyroid (follicular epithelium, parafollicular cells, colloid, etc.) Breast: Breast Page 1 of 2 M D S Molecular Diagnostic Services, Inc. Phone: (858) 450-9990; Fax: (858) 450- 0619; E-mail: [email protected] Hematopoietic: Spleen Tonsil Thymus Bone marrow Respiratory: Lung Cardiovascular: Heart Gastrointestinal Tract: Esophagus Stomach Small intestine Colon Liver Salivary Gland Kidney Prostate Uterus Bladder Cervix Fallopian tube Ureter Uterus-cervix uterus-endometrium Musculoskeletal: Skeletal muscle Skin (epidermis, appendages, dermis) Placenta Lymph node Mesothelial cells: Lining cells from chest wall, abdominal wall, pericardium or from the surface of gastrointestinal, heart and/or lung samples Other: Please List (Please Limit Your Comments to 300 characters): Page 2 of 2
