Submission form
Genetics Dog/Cat
Customer-No. / Barcode
Business Hours: Mo - Fr: 8:00 - 19:00 h, Sa: 9:00 - 13:00 h
Clinic address:
Owners address:
(stamp or block letters)
(block letters only, please)
Name:
Invoice to:
Veterinarian
Owner
_______________________________________
First name:_______________________________________
Street:
_______________________________________
_________________________
(owners signature for direct
Zipcode/city:
_______________________________________
invoicing)
Fax/e-mail:_______________________________________
Fax/e-mail:
_________________________________________________
Tel.:
_______________________________________
Notification:
Courier
8105
E-mail
Fax
Mail
Report copy to owner
Certificate 7,15 €
I have checked the animals identity and assure that samples are taken from the animals mentioned below.
Name:
____________________________________________________-
Signature / Stamp_________________________________________________
veterinarian:
Patient-ID:_________________________________________
Date of sampling:
______________________________________
Please note: Indication of breed is absolutely required!
Animal 1 (MUST BE FILLED OUT - if known, in Capital letters, please)
Sample:
0,5 ml EDTA-blood
Name:
___________________________________________________________________
Date of birth: _______________________________________
Breed:
___________________________________________________________________
Coat colour:
swab
blood card
Sex:
F
Pedigree-No.: ___________________________________________________________________
Tatoo-No.:
M
_______________________________________
_______________________________________
Microchip-No.: ___________________________________________________________________
Sample label:
_____________________________________
Animal 2 (MUST BE FILLED OUT - if known, in Capital letters, please)
Sample:
0,5 ml EDTA-blood
Name:
___________________________________________________________________
Date of birth: _______________________________________
Breed:
___________________________________________________________________
Coat colour:
swab
blood card
Sex:
F
Pedigree-No.: ___________________________________________________________________
Tatoo-No.:
M
_______________________________________
_______________________________________
Microchip-No.: ___________________________________________________________________
Sample label:
_____________________________________
Animal 3 (MUST BE FILLED OUT - if known, in Capital letters, please)
Sample:
0,5 ml EDTA-blood
Name:
___________________________________________________________________
Date of birth: _______________________________________
Breed:
___________________________________________________________________
Coat colour:
swab
blood card
Sex:
F
Pedigree-No.: ___________________________________________________________________
Tatoo-No.:
M
_______________________________________
_______________________________________
Microchip-No.: ___________________________________________________________________
Sample label:
_____________________________________
Credit card
Visa
Mastercard
Total amount:________________________________________________________________
Invoice-No.:
_________________________________________________
Credit card No.:
________________________________________________________________
Exp.
_________________________________________________
date:
Cardholders name:
______________________________________________________________ Cardholders signature:
_______________________________
For accepting credit card we charge EUR 2,10 plus VAT.
Please note: The genetic tests for horses can be found on lab order "Horse"
D000150050103D
000150050103
Dog
Hereditary Diseases (Sample Material: 0,5 - 1 ml EDTA-blood, Buccal Swabs)
8193
Arrhythmogenic Right Ventricular Cardiomyopathy*
(ARVC)
(Boxer)
8219
8062
Canine Leucocyte Adhesion Deficiency (CLAD)
(Irish Red and White Setter, Irish Setter)
8120
Collie Eye Anomaly* (CEA) OPTIGEN
(Australian Shepherd, Bearded Collie, Border Collie, Boykin Spaniel, Hokkaido,
Lancashire Heeler, Longhaired Whippet, Nova Scotia Duck Tolling Retriever, Rough,Smooth Collie, Shetland Sheepdog)
8434
Congenital Hypothyroidism with goiter (CHG)
(Spanish Waterdog)
8000
Copper Toxicosis (CT)
(Bedlington Terrier)
8013
Cystinuria
(Newfoundland, Landseer)
8158
Degenerative Myelopathy (DM)
(All breeds)
8194
Dilated Cardiomyopathy* (DCM)
(Doberman)
8406
8407
Dry Eye Curly Coat Syndrome (CCS)
8069
8151
Factor VII Deficiency
Familial Nephropathy* (FN)
Familial Nephropathy (FN)
8011
Glycogen Storage Disease (GSDIIIa)
(Curly Coated Retriever)
8066
GM1-Gangliosidosis
Grey Collie Syndrome (Canine Cyclic Neutropenia)
8452
(Beagle)
Retinal Atrophy
8135
8451
Hemophilia B (Factor IX deficiency)
Hereditary Cataract (HSF4)
Hereditary Myopathy (CNM)
(American Cocker Spaniel, American Eskimo Dog, Australian Cattle Dog, Australian
Shepherd, Australian Stumpy Tail Cattle Dog, Chesapeake Bay Retriever,
Hereditary Nasal Parakeratosis (HNPK)*
Chinese Crested, Cockapoo, Dwarf Poodle, English Cocker Spaniel, Entlebucher
Mountaindog, Finnish Lapphund, Golden Doodle, Golden Retriever, Kuvasz,
Lapponian Herder, Labrador Retriever, Labradoodle, Markiesje, Nova Scotia Duck
Tolling Retriever,
Norwegian Elkhound, Portuguese Waterdog, Swedish Lapphund, Toy Poodle, Spanish
Water Dog, Silky Terrier, Yorkshire Terrier)
Hereditary Necrotizing Myelopathy (HNM)*
Hereditary Neuropathy (GHN)
Hyperuricosuria (SLC)
8002
(All breeds)
8437
8002
Junctional Epidermolysis Bullosa (JEB)
Juvenile Dilatative Cardiomyopathy (JDCM)*
Juvenile Epilepsy*
(Lagotto Romagnolo)
8197
rcd 2-PRA* OPTIGEN
(Collie)
8002
(Portuguese Waterdog)
8459
rcd 1a-PRA
(Sloughi)
8153
(German Shorthaired Pointer)
8204
rcd 1-PRA
(Irish Setter, Irish Red and White Setter)
Ichthyosis
(Golden Retriever)
8198
GR_PRA1
(Golden Retriever)
(Greyhound)
8154
Generalized PRA
prcd-PRA
8094
performed by OPTIGEN*
8127
performed by partnerlab*
(Dutch Kooiker)
8179
Dominant Form of PRA
(Schapendoes)
8200
(Labrador Retriever)
8421
crd-PRA
(Standard Wirehaired Dachshund)
8002
(Labrador Retriever)
8421
Primary Open Angle Glaucoma (POAG)
(Bull Mastiff, English Mastiff)
Hemophilia A (Factor VIII deficiency)
(Australian Shepherd, Wäller)
8073
Primary Lens Luxation (PLL)
(Chinese Crested, Jack Russell Terrier, Jagd Terrier, Lancashire Heeler, Miniature Bull
Terrier, Parson Russell Terrier, Patterdale Terrier, Rat Terrier, Sealyham Terrier, Tibet
Terrier, Toy Fox Terrier, Volpino Italiano, Welsh Terrier)
(Rhodesian Ridgeback)
8157
Polyneuropathie (AMPN)
(Alaskan Malamute)
8226
(Bichon Havanese)
8221
Phosphofructokinase Deficiency (PFKD)
(American Cocker Spaniel, English Springer Spaniel, Whippet, Wachtelhund)
8479
(Collie)
8232
Osteogenesis imperfecta
(Shorthaired, Wirehaired Dachshund)
8017
(Husky, Portuguese Waterdog)
8098
Night Blindness (CSNB)
(Briard)
8215
(Cairn Terrier, West Highland White Terrier)
8156
Neuronal Ceroid Lipofuscinosis (NCL)
(American Bulldog, Australian Shepherd, Border Collie, Dachshund, English Setter,
Tibet Terrier)
Fucosidosis
Globoid Cell Leucodystrophy / Krabbe-disease
Neonatal Encephalopathy (NEWS)
(Standard Poodle)
(English Springer Spaniel)
8007
Neonatal Cerebellar Abiotrophy (NCCD)
(Beagle)
(English Springer Spaniel, Samoyed)
8016
Necrotizing Meningoencephalitis (MNE)
(Pug)
8457
(English Cocker Spaniel)
8192
Narcolepsy
(Doberman Pinscher, Labrador Retriever)
8429
(Airedale Terrier, Alaskan Klee Kai, Beagle, Giant Schnauzer, Scottish Deerhound)
8131
Myotonia Congenita
(Miniature Schnauzer)
8067
8075
(Boykin Spaniel, Chesapeake Bay Retriever, Curly Coated Retriever, German
Wirehaired Pointer, Labrador Retriever, Pembroke Welsh Corgi)
Myostation mutation("Bully-Gen")
(Whippet)
8022
Dry Eye Curly Coat Syndrome (CCS) +
Episodic Falling
Exercise Induced Collapse (EIC)
Musladin-Lueke Syndrome (MLS)
(Beagle)
8220
(Cavalier King Charles Spaniel)
(Cavalier King Charles Spaniel)
8152
Muscular Dystrophy
(Cavalier King Charles Spaniel, Golden Retriever)
8411
8155
Episodic Falling (EF)
Mucopolysaccharidosis Type VII (MPS)
(German Shepherd)
8068
(Cavalier King Charles Spaniel)
8202
MDR1 Gene Defect* (Ivermectin Sensitivity)
(American White Shepherd, Australian Shepherd, Bobtail, Border Collie, Elo, German
Shepherd, Longhaired Whippet, Mc Nab, Rough,- Smooth Collie, Shetland Sheepdog,
Silken Windhound, Waeller, Weißer Schweizer Schäferhund)
Brachyury
(Breeds upon request)
8012
Malignant Hyperthermia (MH)
(All breeds)
8032
rcd 3-PRA
(Welsh Corgi)
8435
rcd 4-PRA
(Gordon Setter, Irish Setter, Tibet Terrier)
Juvenile Renale Dysplasia (JRD)*
(Breeds upon request)
8125
L-2-Hydroxyglutaric Aciduria (L-2-HGA)
(Staffordshire Bull Terrier)
In order to allow the breeding club discount please enclose a breeding club membership confirmation to each sample
submission. The invoice can not be altered subsequently.
D000000000001D
000000000001
Dog
Hereditary Diseases (Sample Material: 0,5 - 1 ml EDTA-blood, Buccal Swabs)
8104
Pyruvat Dehydrogenase Phosphatase 1 Deficiency
von-Willebrand-Disease
(Clumber, Sussex-Spaniel)
8210
8015
von-Willebrand-Disease
(Dutch Kooiker)
Pyruvatkinase Deficiency (PK Deficiency)
(Basenji, Beagle, Labrador Retriever, Pug, Westhighland White Terrier)
8119
8150
(Labrador Retriever, Samoyed)
8191
Startle Disease
(Irish Wolfhound)
von-Willebrand Disease Type 1
(Bernese Mountain Dog, Coton de Tulear, Doberman, Drentsche Patrijshond, German
Pinscher, Labradoodle, Manchester Terrier, Kerry Blue Terrier, Papillon, Pembroke
Welsh Corgi, Poodle, Stabyhound)
Retinal Dysplasia* (OSD) OPTIGEN
8014
von-Willebrand Disease Type 2
(German Shorthaired Pointer, German Wirehaired Pointer)
8143
Trapped Neutrophil Syndrome (TNS)
(Border Collie)
8233
von-Willebrand Disease Type 3
(Scotch Terrier, Sheltie)
8456
Dwarfism (Skeletal Dysplasia 2)
(Labrador Retriever)
8142
Dwarfism
(Czechoslovakian Wolfdog, German Shepherd, Saarloos Wolfdog)
Coat Colours / Coat Length (Breeds upon request) (Sample Material: 0,5 - 1 ml EDTA-blood, Buccal Swabs)
8144
8023
8196
A-Locus (Agouti)
B-Locus (Coat Colour Brown)
8195
8124
8405
Curly
Furnishing
Coat Length
Improper Coat
(Portuguese Waterdog)
8136
8018
8458
D-Locus (Dilution)
E-Locus
(Coat Colours Yellow, Lemon, Red, Cream, Apricot)
EG-locus domino/grizzle
8145
8185
8180
(Afghan Hound, Saluki)
8146
EM-Locus (Melanistic Mask Allele)
K-Locus
K-Lokus* (brindle)
Sable*
(English Cocker Spaniel)
8438
S-Locus*
DNA-Profile / Parentage** (Sample Material: 0,5 - 1 ml EDTA-blood)
8109
Parentage verification
8212
Likelihood ratio calculation (incl. DNA-Profile)
(Breeds upon request)
8107
DNA-Profile (each parent)
(Identity confirmation)
8211
Breed Analysis (DNA-Profile + assignment)
(Breeds upon request)
For parentage evaluation DNA profiles of each parent is needed.
If only sample material from one parent is available we would like you to contact us prior to submitting the samples.
In order to allow the breeding club discount please enclose a breeding club membership confirmation to each
sample submission. The invoice can not be altered subsequently.
D000000000002D
000000000002
Cat
Hereditary Diseases (Sample Material: 0,5 - 1 ml EDTA-blood, Buccal Swabs)
8002
8453
Gangliosidosis (GM 1/GM 2)
(Korat, Oriental Shorthair, Siamese)
8149
Gangliosidosis (GM2)
(Burmese)
8113
Polycystic Kidney Disease (PKD)
(Persian and related breeds)
Glycogen Storage Disease (GSD) Type IV
8117
(Norwegian Forest Cat)
8465
Hypokalemia*
(Burmese)
8013
Progressive Retinal Atrophy (rdAc-PRA)
(Abyssinian, American Curl/Wirehair, Balinese, Bengal, Colorpoint Shorthair, Cornish
Rex, Javanese, Munchkin, Oriental Shorthair, Singapura, Siamese, Somali, Tonkinese)
Head Defect*
(Burmese)
8080
8015
Hypertrophic Cardiomyopathy (HCM)
Mutation 1 Meurs (G --> C)(Maine Coon)
8116
Pyruvatkinase Deficiency (PK)
(Abyssinian, Bengal, Domestic Shorthair and Longhair, Egyptian Mau, La Perm,
Occicat, Maine Coon, Norwegian Forest, Savannah, Siberian, Singapura, Somali)
Hypertrophic Cardiomyopathy (HCM)
8123
(Ragdoll)
Feline Spinal Muscular Atrophy (SMA)
(Maine Coon)
Coat Colours / Coat Length (Sample Material: 0,5 - 1 ml EDTA-blood, Buccal Swabs)
8090
8170
Coat Colour Variant Agouti
(All breeds)
8086
Coat Colour Variant Burmese
(All breeds)
8085
Coat Colour Chocolate
(All breeds)
8083
Coat Colour Variant Siamese (Point)
(All breeds except Bengal)
8099
Coat Colour Amber
(Norwegian Forest Cat)
8084
Coat Colour Cinnamon
(All breeds)
8147
Coat Colour Variant Dilution
(All breeds)
Coat Length
(All breeds)
Blood Group Testing
8121
618
Genetical Blood Group Testing
(All breeds except Turkish Angora, Ragdoll, Sibirian, Neva Masquerade, European
Shorthair)
Serological Blood Group Testing
(only EDTA Blood)
(All breeds)
Serological evaluation of the blood group is needed to differentiate between groups A, B and AB. Prior to any blood transfusion both
donor and recipient should be tested to avoid incompatibilities. SAMPLE MATERIAL: EDTA BLOOD
Additional genetic testing of the blood group is helpful prior to selection of mating partners especially in case of the queen being group
A or AB due to the fact that group A animals can carry and pass on the recessive b gene for group B.
SAMPLE MATERIAL: EDTA BLOOD OR SWAB
DNA-Profile / Parentage** (Sample Material: 0,5 - 1 ml EDTA-blood)
8109
8211
8107
Parentage verification
DNA-Profile (each parent)
Breed Analysis (DNA-Profile + assignment)
(Breeds upon request)
For parentage evaluation DNA profiles of each parent is needed.
If only sample material from one parent is available we would like you to contact us prior to submitting the samples.
* Partnerlab
**Additional Information DNA-Profile:
Please send in samples from both parents even if only the parentage of the Father has to be verified.
All animals with possible parenthood should be tested.
Sampling should be performed by an officially appointed person if the result is going to be part of a legal issue.
1) The identity of the animal needs to be confirmed by a veterinarian (specified by Microchip-No, Tattoo-No.)
2) Certificates are not issued for partner laboratory services and genetic blood group testing of cats
3) Certificates are included in the services of DNA-profile and parentage testing
In order to allow the breeding club discount please enclose a breeding club member confirmation to each sample
submission. The invoice will not be altered subsequently.
Supply order:
D000000000003D
000000000003
55
Cytobrushes (DNA-tests)
64
Submission forms - GENETICS
Business Conditions:
All statements according to our conditions see (www.laboklin.com) / All terms and prices are subject to changes.
* = partnerlab
015.005 12/11