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.
Referring Veterinarian
*
Preferred Contact:

PhoneEmail
Preferred Veterinarian*

Dr. Etta BradecampDr. Maria SchnobrichDr. Charlie ScogginDr. Peter SheerinNo preference
Date Collected *

MonthDayYear
Date
*
Reproductive Status*

MaidenWetDryBarren
*
Body Condition Score*
Body Condition*

PoorFairGoodObese
Stage of Cycle*

EstrusDiestrusTransitionAnestrus
Perineum*

Caslick's - YesCaslick's - No
Dorsal Displacement (cm):*
Anterior Slope (degrees):*
Pneumovagina*

YesNo
Palpation & Ultrasound*
Cervix*

NormalAbnormal
Describe:
Cytology*

InflammatoryNon-inflammatoryPendingNot Done
Cell Type(s):
Culture*

PositiveNegativePendingNot Done
Organisms:
Previous Biopsy*

YesNo
Breeding History*
Should be Empty:

Owner Information