Stomach Cancer Study
Tufts Harrington Oncollogy Program
Please use the pdf form available here. If you cannot view the form then print these pages.
Formalin fixed samples
FedEx the samples
|Fresh sample (place in red top or centrifuge tube)
o Tumor or “abnormal Looking” stomach
o “Normal Looking” stomach (if there is any)
o Healthy liver or spleen
Please freeze immediately and ship on ice packs. Keep in freezer until ready to ship.
Dr. Elizabeth McNiel, DVM, PhD
Tufts Medical Center
75 Kneeland Street
14th Floor Room #14047
Boston, MA 02111
o Please fill in the total weight of the package on the Fed Ex form
o Please call for FedEx account information and with any questions you may have.
|If samples are taken on a Friday: please refrigerate blood. Ship out on Monday.|
-----------------Return Below Portion with Shipment---------------------------------------------
Affected participants: (Please include biopsy report if available)
Date of Diagnosis ___________________ Biopsy Diagnosis ______________________
Biopsy Location ______________________ Other Disease __________________________
Phone: ___________________________________ Email:_____________________
Call Name: _______________________________ Date of Birth:_______________
Registered Name: ________________________________________________
Breed:________________ AKC (or Other) Registration #: ________________________________ Please attach pedigree if available
Sex: Male, Male Neutered, Female, Female Spayed (circle one)
Please Acknowledge and Sign:
I give Dr. Elizabeth McNiel and her direct collaborators permission to use this sample for research purposes. I understand that any pedigree information or data specific to my dog will be kept confidential and any publications resulting from these studies will not include any information that will make it possible to identify a subject. In addition, I understand that I will not receive individual results regarding my dog as a result of these studies.
Signature: ________________________________ Date:_____________