Spinone Club of America

Spinone Italiano
 - Leishmaniasis -
Serum Sample Submission Form
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1. Complete the following Information (Required):

DOG INFORMATION
Breed of Dog Spinone Italiano
Registered Name
of Dog:		  
Add'l Identification
(Tatoo, Microchip#, etc.)		  
Sex:
(male or female)		  
Has dog been
Neutered? (yes or no):		  
Date of Birth
or Age in years/months:		  
Place of Birth (Domestic) or
If Foreign (What Country and
when imported?):		  

OWNER INFORMATION
Owners
Name(s):		  
Owners
Address:		  
Owners
City, State  Zip code
 		  
Owners
Phone Number		  

VETERINARIAN INFORMATION (Submitter of Sample)
Veterinarian and/or
Vet Clinic Name		  
Vet.
Address:
 		  
Vet.
City, State  Zipcode:		  
Vet. Phone:
 		  
Vet. Fax:
 		  

Please sign and date below if you authorize release of these test results to the Breed Health Committee of the Spinone Club of America

Signature:________________________________________ Date:____________________

 

 

2. Blood Serum Sample Collection:
  • It needs to be a "SERUM" sample of approximately 1.0cc.
  • The sample does NOT need to be cooled.
  • Secure packaging of sample to avoid breakage and leaks.
3.  Where to Ship Serum Samples:

Send the Sample Submission Form and the Blood Serum Sample to:

Mr. Frank Steurer
CDC Division of Parasitic Disease
Building 8, Room 30
4770 Buford Highway
Atlanta, GA 30341
Phone:  770-488-4475
4. When to ship:

Samples should NOT arrive at the CDC on the Weekend or Holiday, it is best to ship it via an overnight delivery service.

If you have any questions regarding sampling or test results call:
Peter M. Schantz, VMD, PhD
Phone:  770-488-7767

Note:  Call Mr. Steurer for results and information ONLY if you are unable to contact Dr. Schantz.