HistoCare Sample Submission Form
Name
*
First Name
Last Name
Email
*
example@example.com
Contact Information
*
Institution
Street Address
City
State / Province
Postal / Zip Code
Billing Information
*
Institution
Street Address
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Payment Method is required for efficient turnaround of results
*
PO# - Purchase Order, (enter PO# below)
VCC - Institution Virtual Credit Card
Credit Card- Visa, Mastercard, Amex
Paypal
Please Enter PO# here.
Sample Information: To the best of my knowledge these samples and/or specimens do not contain any infectious agent or material which might pose a threat to human health. If this is not the case please call HistoCare before sending samples. Signature
*
Sample Source
Please Select
Clinical
Research
Other
Date
*
-
Month
-
Day
Year
Date
How Are You Sending Samples?
*
I will send directly to HistoCare Service Lab
I will require Sample Collection Service
What Samples are you Submitting?
*
FFPE Blocks
Slides
Wet Cell block
Wet Biopsy
Scrolls
What Service do you Require?
*
Please Select
First Unstained Sections from submitted FFPE (3day- £11.75)
Extra Unstained Section from submitted FFPE (3day- £2)
First Unstained Section From submitted FFPE (10day £9.75)
Extra Unstained Section from submitted FFPE (10day £1)
HE Staining (3day £3.75)
HE Staining (10days £3.25)
Wet Biopsy Processed to FFPE Block (3day £20)
Wet Biopsy Processed to FFPE Block (10day (17.50)
DNA Extraction from FFPE Block (£55)
DNA Extraction From Slides/Scroll (£47)
RNA Extraction From FFPE Block (£58)
RNA Extraction From Slides/Scroll (£50)
For Multiple Sample Request contact HistoCare for a quote
File Upload
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Further Instructions
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