Histology Services Request Form

Updated 1/13/21

Requester Information

Last Name*

Please enter Last Name of submitter

First Name*

Please enter First Name of submitter

Email Address*

PI Last Name*

Please enter Last name of the lab PI

Is this an Internal or External Request?*

Internal (Sanford)

Academic/Non-Profit

External

Accounting Unit (eg. 800-12345)*

This will be a 3-digit company number (e.g. 800 for research) followed by a 5-digit AU number (the same number you use for ordering supplies). Required for tracking purposes. If a charge is assessed, you will be notified before we begin the request.

Organization*

Please enter the name of your organization

Address*

Please enter the address of your organization

Services Required

Do you need a quote?

Yes

Do you need paraffin embedding?*

Yes

How many samples need embedding?

Please enter the number of tissue samples you would like to have embedded

Do you need tissue sectioning?*

Yes

Sectioning type*

FFPE/Paraffin Sectioning

Cryosectioning

Vibratome Sectioning

# of FFPE Blocks*

How many FFPE sections per block?*

Please indicate how many sections you would like from each block

Number of FFPE sections/slide*

Please enter the number of sections you would like on each slide

Special Instructions for FFPE sections

Please enter any special instructions

# of frozen samples*

How many cryosections per sample?*

Number of cryosections/slide*

Please enter the number of sections you would like on each slide

Special instructions for cryosections

Please enter any special instructions

Do you need post-fix?*

Yes

If yes, please detail requirements below

How many samples do you have for Vibratome sectioning?*

Vibratome thickness*

Partial or full sections*

Select or enter value

Vibratome Notes

Do you need Special Stains?*

Yes

Which Special Stains do you need?

Select all that apply

Select or enter value

How many slides for Movat Pentachrome?

How many slides for Masson's Trichrome?

How many slides for PAS?

How many slides for special 3?

Do you need H & E Staining?*

Yes

How many slides need H & E?

Do you need IHC?*

Yes

Do you want Immunofluoresence?

We can currently support up to two colors

Yes

Which fluorophores do you want?

Select all that apply

Select or enter value

Do you want DAPI counterstaining?

Yes

Please list antibodies?

How many slides per antibody?

Comments/Special Instructions

Please add any special instructions regarding antibody staining here

General Comments

Send me a copy of my responses

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