Cytology Request Form — cytovet

Service required

Practice Name

Vet Name

Email address for results and invoice

Owner Name

Animal Name

Date

MM

DD

YYYY

Species and Breed

Sex

Age

Specimen (mark as appropriate)

FNA

Impression Smear

Body Cavity Fluid

Other

*if other please specify

Lesion Location

Lesion Description

History/Clinical Synopsis

Cytovet - Cytology Request Form

*If the sample is urgent please contact Cytovet, same day turnaround is possible for an additional charge*