Equine DNA Test Submission Form

Equine DNA Test Submission Form
Please complete the form to the best of your knowledge. Some test are preformed by
partner labs or labs located outside the UK. Results of these tests may take a little extra time.
Send 30-40 mane or tail hairs pulled with roots attached in a plastic zip-lock bag.
Label bag with the horse’s name as indicated on this form.
Include cheque, money order or credit card information for the appropriate amount.
Post samples to the address indicated below.
Results are sent to Svenska Tinkerhästsällskapet
(Swedish Tinker Horse Association)
Account #
Owner Info
Address:__________________________________________________ City:______________________________________
Registry Info (If known)
Name:_______________________________________ Business Name:__________________________________________
Horse Name:_________________________________________Registration #:_______________________________
County/State:__________________________ Post Code:____________________ Country:__________________________
E-Mail Address:____________________________________________Phone/Fax:_________________________________
Year of Birth:_______ Sex:_______ Breed:____________________________Colour:__________________________
Sire's Name:______________________________________Reg #:_________________________________________
Breed:____________________________________ Colour:_______________________________________________
Dam's Name:______________________________________Reg #:_________________________________________
Breed:____________________________________ Colour:_______________________________________________
 Red Factor
 Agouti (Bay/Black)
 Splashed White (SW-1, SW-2, SW-3)
Required Tests
 Lethal White/Frame Overo
 Appaloosa (LP) or (CSNB)
 Tobiano
 Sabino1
 Dominant White (W5, W10)
 Cream Dilution
Congenital Stationary Night Blindness (CSNB) or (LP) 
Hereditary Equine Regional Dermal Asthenia (HERDA)
Hyperkalemic Periodic Paralysis (HYPP)
Glycogen Branching Enzyme Deficiency (GBED)
Junctional Epidermolysis Bullosa (JEB1, JEB2)
Polysaccharide Storage Myopathy (PSSM)
Malignant Hyperthermia (MH)
 Cerebellar Abiotrophy (CA)
 Lavender Foal Syndrome (LFS)
 Severe Combined Immunodeficiency Disease (SCID)
 Champagne Dilution
 Pearl Dilution
 Silver Dilution
Individual DNA Profile (ISAG profile)
Foal _____________________________ Mare _____________________________
 Grey
Parentage Verification
Sire 1_____________________________ Sire 2_____________________________
Om du önskar göra fler tester än mot PSSM1, kontakta vår kontaktperson (se hemsida). Observera att provsvaren kommer att
skickas till STS som meddelar dig som hästägare resultatet. Om du inte vill testa för PSSM1, vänligen kontakta labbet på egen hand.
Om du använder detta formulär tillsammans med remiss för DNA-provtagning behöver du ej ange betalinformation, du betalar enligt
information på vår hemsida (pris kan variera pga växlingskurs). Postens avgifter tillkommer om annat ej avtalats.
UK is not responsible for the origin/source of samples submitted by the individual customer.
By submitting this form, the customer understands that Animal Genetics shall in no way be liable for any incidental or consequential damages of any kind. Animal Genetics