Uterine Biopsy Submission Sheet

Uterine Biopsy Submission Sheet
LeBlanc Reproduction Center
Staff Theriogenologists:
Etta Bradecamp, DVM, DACT, DABVP
Maria Schnobrich, VMD, DACT
Charlie Scoggin, DVM, MS, DACT
Pete Sheerin, DVM, DACT

2150 Georgetown Road
Lexington, KY 40511
(859) 233-0371
www.roodandriddle.com
Owner Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Referring Veterinarian
Email*
example@example.com
PhoneEmail
Dr. Etta BradecampDr. Maria SchnobrichDr. Charlie ScogginDr. Peter SheerinNo preference
Date Collected *

MonthDayYear
Date
MaidenWetDryBarren
Body Condition Score*
PoorFairGoodObese
EstrusDiestrusTransitionAnestrus
Caslick's - YesCaslick's - No
Dorsal Displacement (cm):*
Anterior Slope (degrees):*
YesNo
Palpation & Ultrasound*
NormalAbnormal
Describe:
InflammatoryNon-inflammatoryPendingNot Done
Cell Type(s):
PositiveNegativePendingNot Done
Organisms:
YesNo
Breeding History*
Should be Empty:

Owner Information