Ocala Veterinary Diagnostics Submission Form General Submission Form An automatic email of this form will be sent to the submitting veterinarian. Please check the Spam Folder & mark as Not Spam for future requests. Lab RequestSubmitting VeterinarianClinic NameStreet AddressCityStateZip CodePhoneSubmitting Vet’s SignatureEmailNew or Returning Veterinarian New Returning-Info is on fileVeterinarian Accreditation # FL Veterinarian IDOwner First NameOwner Last NameStreet AddressCityStateZip CodeOwner PhoneOwner Email Animal Identification:NameBreedSex Male Intact Female Intact Castrated Male Spayed FemaleAge or Date of BirthMicrochip or Registration Number Test(s) RequestedHEM/CHEM Panels-Select-CBCCBC/IgG (semi)CBC/Chem/IgG (semi)Health-CBC, ChemMedicine-CBC, Cr, LytesChemistry Panel-Select-Comprehensive Chemistry PanelElectrolyte + Chemistry PanelIgG: QuantitativeIgG: Semi-quantitativeSerum Amyloid AEIA/COGGINS-*May select multiple test types*- 2 HR ELISA (blood must be at the lab by 3 pm) Same Day ELISA Next Day AGID 92 HR AGID# of Test Samples-2 HR# of Test Samples-Next Day# of Test Samples-72 HRParasitology/Virology-Select-C. Difficile A/BC. PerfringensEquine Influenza VirusFecal FloatOccult BloodRotavirusEndocrinology-Select-ACTHACTH w/insulinACTH/Cort/InsulinEstrone SulfateInsulin BaselineP4 ProgesteroneT4 ThyroidTestosteroneCytology-Select-Gram StainCyt. Slide OnlySynovial Fluid AnalysisComplete UrinalysisWBC/TPMicrobiology - On Antibiotics? Yes NoMicrobiology-Select-BloodFluidFluid w/SensitivityFungalFungal w/SensitivityNasalNasal w/SensitivitySalmonellaStallionStallion w/SensitivityTTW w/SensitivityTrans Tracheal WashUrineUrine w/SensitivityWoundWound w/SensitivityUterine (Plated/Growth)Uterine CytologyUterine Cytology w/SensitivityUterine ONLY SensitivityHistopathology- Select -Histopathology Level 1Histopathology Level 2REQUIRED-click here to complete details on HistopathologySpecial Testing-Select-Allergy Test-RegionalCEM CultureCEM TiterEHV-5 UKEMP TiterEVAHYPPKaryotypingLawsonia SerologyLymes Disease TiterNI Antibody Screen (call lab prior to sample collection)Piroplasmosis Complement FixationStrep equi PCR/CultStrep M ProteinDrug Screens-Select-Drug Screen-Level 1Drug Screen-Level 2Miscellaneous Services-Select-AutoclaveClean & AutoclaveSharps DisposalSpecial InstructionsSubmit Form