PI Name
Last name
First name
PI Email Telephone
Project name Project start date YYYY-MM-DD Coordinator email University / Business Work phone Cel Project address City Province Postal Code Country
Sample 1 (type)—Veuillez choisir une option—SalivaHairWhole bloodSerumPlasma
Sample 2 (type)—Veuillez choisir une option—SalivaHairWhole bloodSerumPlasma
Sample 3 (type)—Veuillez choisir une option—SalivaHairWhole bloodSerumPlasma
If saliva, indicate method of collection—Veuillez choisir une option—Cryo vial-passive droolSalivetteChildren' swapOther
Échantillon 1
Échantillon 2
Échantillon 3
Alpha-amylase *previously run in singlet now run in duplicate, unless otherwise requested.
Androstenedione
Cortisol
CRP
DHEA
DHEAs
Estradiol
Estriol
Progestérone
Testostérone
Secretory Iga
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.
