Gene Check, Inc.
1175 58th Ave., Suite 100
Greeley, CO 80634
Toll Free: 800-822-6740
Phone: 970-472-9951
Fax: 970-472-9956
Email: genecheck@genecheck.com www.genecheck.com
OWNER INFORMATION
VETERINARIAN INFORMATION (optional)
NAME:
NAME:
FARM NAME (IF APPLICABLE):
MAILING ADDRESS:
MAILING ADDRESS:
CITY, STATE, ZIP:
CITY, STATE, ZIP:
PHONE:
FAX:
PHONE:
E-MAIL:
FAX OR E-MAIL:
TESTING INFORMATION
Test Code
Test Type
171
Scrapie Susceptibility Codon 171 (RR, QR, QQ): $11
136
Scrapie Susceptibility Codon 136 (AA, AV, VV): $11
SPIDER
Spider Lamb Syndrome: $11
DERMA
Dermatosparaxis : $24($20 for ADSBS members)
ED
Ectodermal Dysplasia(Hairy Lamb): $13($11 for ASBA members)
CAL
Callipyge Gene : $13
PSS
Porcine Stress Syndrome (PSS) : $22
CWD 132
Chronic Wasting Disease–Elk (Codon 132) : $17
CWD 96
Chronic Wasting Disease-Deer (Codon 96) : $17
JOHNE’S
OPP
Johne’s for Sheep or Goat : $7
Ovine Progressive Pneumonia (OPP or CAE) : $7
Accepted Samples
Shipping Methods
**Please place enough postage on your package-any bulk
over 1/4 inch is considered a package, not an envelope.**
2-3 cc whole blood in “purple top” Ship blood in well padded box. Ship on ice in warmer
months. Blood should arrive within 2-3 days of shipping.
EDTA tube (Be sure to rock tube
back and forth after collection)
3-5 business days
DNA Ear tag or Ear sample only
collectors (tissue sample)
Ear tags and sample only collectors can be sent regular mail
(NO regular envelopes) and do not need refrigeration.
Whatman FTA blood cards
FTA cards can be sent regular mail. Please be sure to add
enough postage.
Serum from “Red top” serum
separator tube OR 2-3 cc whole
blood in EDTA tube.
Ship blood/serum in well padded box. Ship on ice in warmer
months. Blood should arrive within 2-3 days of shipping.
PAYMENT METHOD
Check Enclosed
Card #:____________________________________________________
Charge my Visa / Mastercard / Discover (circle one)
Exp. Date:_______3 digit CSC/CVC code(on back right of card)____________
Cardholder name (Print name):
Signature:
__________________________________________________________
Time
________________________________________________________________________
Note: We do NOT store credit card information on file.
Please flip over to fill out sample information
3-5 business days
NO RUSH OPTION
SAMPLE INFORMATION-Please Print Clearly
Notes:
PSS
CWD 96
CWD 132
CAL
OPP
JOHNE’S
Goat
JOHNE’S
Sheep
ED
DERMA
Scrapie
Susceptibility
136
Animal ID
171
#
SPIDER
***Please place an “X” under the desired test column for each sample.***
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Would you like a 48-hour rush on any samples?
*NO RUSH OPTION FOR OPP or JOHNE’s*
YES - $10 additional charge per test, per animal. ***Please write “RUSH” next to each animal ID you wish to have rushed.***
**All tests are performed by Gene Check, Inc using naturally occurring DNA sequences.**