Disease Research Laboratory 4th Floor (414) Microbiology Department University of Otago 720 Cumberland Street Dunedin __________________________________________________________________________ Johnes Faecal PCR sample Request Form Laboratory Requirements All samples booked in by phone or email prior to sending will be given priority processing If results are urgent then please let the laboratory know at the time of booking. Phone: 03 479 7710 Email: drl@otago.ac.nz 1x screw cap specimen pottle clearly identifying animal is required for the faecal PCR test. (No gloves or plastic bags please) Processing times Generally samples received by Tuesday will be processed the same week with results being sent the following week Faecal PCR Results Result will be differentially reported depending on the level of shedding .Results will be provided to the vet involved, if indicated by the farmer. No other agency will receive this data. For technical help or results queries please contact Simon Liggett 03 479 7710 simon.liggett@otago.ac.nz Farmer Details Farmer Name: Phone: Farm Name: Email: Postal Address: Vet Details Vet Name: Phone: Vet Clinic: Email: Postal Address: Invoice to be sent to: Farmer □ Submitter □ Authorized Signatory______________________ Terms & Conditions University of Otago retains ownership of all information and intellectual property derived from the analysis of samples submitted. The Accounts Receivable Section in the Financial Services Division manages the collection of debt for the University of Otago. A Statement of all invoices issued in the current month is sent to the debtor at the end of the month. It is University practice that all invoices on these statements are to be paid by the 20th of the month following (normal commercial practice) If the debt remains unpaid after 90 days, the debt will be referred to a collection agency, collection costs will be incurred by the debtor Johnes Faecal PCR sample Request Form Farm Tag Sex Age Farm Tag Sex Age