Download Slovgen s

Slovgen s. r. o. , Diagnostic laboratory, ILKOVIČOVA 8, 841 04 BRATISLAVA 4,
Slovak Republic, tel : 004210905 550 916,Reg. No. (ICO): 35700629, VAT: SK2020906151, accounts:
SK5511000000002626252786 (TATRSKBX); CZ8855000000006107902001 (RZBCCZPP); Paypal FS5LN9AAC848S
Slovgen s.r.o. registrated in Register of Companies at District court Bratislava I, in section Sro, number 1939/B
ORDER FORM
GENETIC IDENTIFICATION (DNA PROFILE) AND PARENTAGE TESTING
Genetic identification and parentage testing is perfom by PCR amplification of DNA microsatellite sequences (ISAG Panel)
DNA profile
note: Required tick
Detection of the MDR1 mutation
Owner
(name, surname)
address:
e-mail:
Animal references
Name:
Breed:
Gender:
Identification /Id:
Tattoo number:
chip:
Parentage testing
note: father’s name and mother’s name fill only if the parentage testing is required
father’s name:
Id:
mother’s name:
Id:
Hereby, I confirm that I have taken the biological sample from the animal stated for the purpose of its
examination in Slovgen laboratory. At the same time, I have checked the correctness of the
identification data. I have provided the tube with the biological sample with a label specifying the
correct identification data of the examined animal.
Type of biological material:
Blood
Buccal swab
other:
Date of sampling:
Name of the veterinarian:
Stamp and signature:
Owner signature:
Date:
Date of receipt of sample *:
Animal referenced under
Lab DNA code*:
(*-filled by laboratory)
Sample was received *: