Tufts LogoStomach Cancer Study
Enrollment Instructions
Tufts Harrington Oncollogy Program
Tissue donations

Please use the pdf form available here. If you cannot view the form then print these pages.

Formalin fixed samples
o Tumor or “abnormal Looking” stomach
o “Normal Looking” stomach (if there is any)
o Healthy liver or spleen

Blood Sample
o 6mls in an EDTA tube

FedEx the samples
o Please ship samples on an ice pack

  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.
  Ship to:
Dr. Elizabeth McNiel, DVM, PhD
Tufts Medical Center
75 Kneeland Street
14th Floor Room #14047
Boston, MA 02111
Phone: 617-636-4715 Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
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 __________________________

Owner Information


Mailing Address:______________________________________________

Phone: ___________________________________ Email:_____________________

Dog Information

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:_____________