Histology Service Request Form

Investigator Information


Your Name:

  

Your email address:

  

Telephone Number:

  

Room Number:

  

Charging Instructions:

  

Project

Task

Award

Expenditure

Organization

Material Submitted


Tissues:

  

Yes          No

Tissue ID:

  

Blocks:

  

Yes          No

Block ID:

  

Slides:

  

Yes          No

Slide ID:

  

Requested Service


Embedding only:

  

Yes          No

Embed and HE slide:

  

Yes          No

HE slide only:

  

Yes          No

Unstained slides:

  

Yes          No

Special stains:

  

Yes          No

Frozen sections:

  

Yes          No

     
 

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