Analysis Request

Analysis Request

Principal investigator (PI)

PI Name

• Last name

• First name

PI Email
Telephone

Project Coordinator

Project name
Project start date YYYY-MM-DD
Coordinator email
University / Business
Work phone
Cel
Project address City Province Postal Code Country

Samples

• Sample 1 (type)—Veuillez choisir une option—SalivaHairWhole bloodSerumPlasma

• Sample 2 (type) if necessary—Veuillez choisir une option—SalivaHairWhole bloodSerumPlasma

• Sample 3 (type) if necessary—Veuillez choisir une option—SalivaHairWhole bloodSerumPlasma

• 
  If saliva, indicate method of collection—Veuillez choisir une option—Cryo vial-passive droolSalivetteChildren' swapOther

Indicate # of tubes per sample type *

• treatment after analysis *—Veuillez choisir une option—Return to researcherDestroy after 30 daysLong-term storage (extra costs)Other