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—SalivaUrineHairWhole bloodSerumPlasma

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

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

If there are other analyses that you require, please inform us in the comments box below.

Please indicate whether you will be bringing the samples or shipping them to the analysis and conservation laboratory. If the samples are to be shipped please make sure to follow the instructions on the web site: instructions

If shipping please also include courier name and account #.

If you will be bringing the samples to the lab in person, first contact the lab to arrange a date and time so that the samples can be handed over efficiently.

Comments or instructions

• 
  Sample delivery —Veuillez choisir une option—Delivery by courrierDelivery by postDelivery in person
  

One this form has been submitted you will receive a quotation for the analysis requested. Please read the conditions on the form and then sign and return it. Only when a signed agreement has been received will the sample be analyzed.