Laboratory Submission Form

Laboratory Submission Form

We prefer samples be delivered via UPS or Fed-Ex to ensure timely delivery. Only forms completed by veterinarians will be accepted.
Phone: 859-233-0331
Fax: 859-280-3489

Delivery Service Address: 2150 Georgetown Road | Lexington, KY 40511
US Postal Service Address: PO BOX 12070 | Lexington, KY 40580
Veterinarian Name*

First NameLast Name
Clinic*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email*
example@example.com
Date*

MonthDayYear
Date
Time
Patient Name
Client/Owner*

First NameLast Name
Species*

EquineCanineFelineOther
If other, please provide species
Hematology

Complete CBC (Fib/Diff)CBC (Fib) Pre-SurgeryCBC
Single Hematology

Hct/PCVPlatelet CountTPFibrinogenSerum Amyloid A (SAA)WBC
Fluid Analysis

WBCRBCTPUrinalysisCSF Analysis, WBC, RBC, MTP
Sample Site/Type
Microbiology

Culture/SensitivityCytologyARDAnaerobicBlood CultureBiofilmFecal CultureStallion Culture
Sample Site/Type
Fecal Sample

McMasters (Fecal Float)RotavirusOccult BloodSucceedOva & Parasite (Small Animal)
Urinalysis

Urinalysis
Chemistry Panels

Master PanelBasic PanelMuscle EnzymeFoal Panel (Creat, IgG)Electrolyte PanelMilk ElectrolytesUrine Creatinine
Single Chemistry

AlbAlkPBile AcidsBUNCaCKColostrum IgGCreatD BiliGGTGlucoseIgGIonized CalciumLactateLDHMgNH3PhosSDHSGOT/ASTSGPT/ALTT BiliTriglycerides
Endocrinology

NaKClHC03Ca++
Endocrinology

ProgesteroneT4CortisolInsulinACTH - EDTA plasma (Tues/Thurs Only)
Blood Gas Analysis

Blood Gas Analysis
Coagulation

PTPTT
Immuno Hemotology

Antibody ScreenTransfusion Cross MatchJFA/Colostrum Cross MatchCoombs
Coggins/EIA

AGID (24 hrs)ELISA (2 hrs)ELISA (End of Day)
Other Tests

Heartworm/Lyme/EhrlichiaFeleuk/FIV
Specimens Submitted

Blood WholeCulturette (list origin below)FecesMilkPlasma EDTAPlasma HeparinAbcess (please specify below)TransTracheal WashSerumSmear (please specify below)Synovial Fluid (please specify below)Other Sterile Body Fluid (please specify below)UrineOther (please specify below)
How Many?
Culturette Origin
Absess
Smear
Synovial Fluid
Other Sterile Body Fluid
Other (not listed)
Additional Tests
Should be Empty: