Sample Drop off FormPLEASE INCLUDE PET’S NAME AND OWNER’S LAST NAME ON ALL SAMPLES Pet's Name * Name * First Name Last Name Email * Phone * (###) ### #### Please list the symptoms your pet is currently experiencing: * How long have these symptoms been present? * Have you dropped off a sample for analysis in the past 30days? * Yes No Has your pet been treated with antibiotics in the last 30days? * Yes No Would you like your container back? * Yes No * I am the owner or agent of the above-described animal and have the authority to execute this document. I am responsible for all charges incurred for the testing of the sample and it is understood that payment is due at the time of service. Yes Thank you!