Submission form Genetics Dog/Cat - Laboklin

Submission form 

Genetics Dog/Cat 

Business Hours: Mo - Fr: 8:00 - 19:00 h, Sa: 9:00 - 13:00 h 

Clinic address: 

(stamp or block letters) 

Fax/e-mail: _______________________________________ 

Fax/e-mail: _________________________________________________ 

Tel.: _______________________________________ 

8105 

Courier 

Certificate 7,15 € 

I have checked the animals identity and assure that samples are taken from the animals mentioned below. 

Name: ____________________________________________________- 

Signature / Stamp _________________________________________________ 

veterinarian: 

Patient-ID:_________________________________________ Date of sampling: ______________________________________ 

Please note: Indication of breed is absolutely required! 

Customer-No. / Barcode 

Animal 1 (MUST BE FILLED OUT - if known, in Capital letters, please) 

Sample: 0,5 ml EDTA-blood swab 

blood card 


Sample: 0,5 ml EDTA-blood swab blood card 


Credit card Visa 

Mastercard 

Total amount:________________________________________________________________ 

Street: _______________________________________ 

_________________________ 

Zipcode/city: _______________________________________ (owners signature for direct 

Invoice-No.: _________________________________________________ 

Credit card No.: ________________________________________________________________ Exp. _________________________________________________ 

date: 

Cardholders name: ______________________________________________________________ Cardholders signature: _______________________________ 

For accepting credit card we charge EUR 2,10 plus VAT. 

Please note: The genetic tests for horses can be found on lab order "Horse" 

D000150050103D 

000150050103 

Owners address: 

Invoice to: 

(block letters only, please) 

Veterinarian 

Owner 

Name: _______________________________________ 

First name: _______________________________________ 

invoicing) 

Notification: E-mail Fax Mail Report copy to owner 

Sex: F M 

Name: ___________________________________________________________________ Date of birth: _______________________________________ 

Breed: ___________________________________________________________________ Coat colour: _______________________________________ 

Pedigree-No.: ___________________________________________________________________ Tatoo-No.: _______________________________________ 

Microchip-No.: ___________________________________________________________________ Sample label: _____________________________________ 

Sex: F M 




Microchip-No.: ___________________________________________________________________ Sample label: _____________________________________ 

Sample: 0,5 ml EDTA-blood swab blood card 

Sex: F M 




Microchip-No.: ___________________________________________________________________ Sample label: _____________________________________

Dog 

Hereditary Diseases (Sample Material: 0,5 - 1 ml EDTA-blood, Buccal Swabs) 

8193 

Arrhythmogenic Right Ventricular Cardiomyopathy* 

(ARVC) 

(Boxer) 

8219 

Brachyury 

(Breeds upon request) 

8012 

Canine Leucocyte Adhesion Deficiency (CLAD) 

(Irish Red and White Setter, Irish Setter) 

8120 

8434 

8000 

8013 

8158 

8194 

8406 

Collie Eye Anomaly* (CEA) OPTIGEN 

(Australian Shepherd, Bearded Collie, Border Collie, Boykin Spaniel, Hokkaido, 

Lancashire Heeler, Longhaired Whippet, Nova Scotia Duck Tolling Retriever, Rough,- 

Smooth Collie, Shetland Sheepdog) 

Congenital Hypothyroidism with goiter (CHG) 

(Spanish Waterdog) 

Copper Toxicosis (CT) 

(Bedlington Terrier) 

Cystinuria 

(Newfoundland, Landseer) 

Degenerative Myelopathy (DM) 

(All breeds) 

Dilated Cardiomyopathy* (DCM) 

(Doberman) 

Dry Eye Curly Coat Syndrome (CCS) 

(Cavalier King Charles Spaniel) 

8407 

8202 

8152 

8151 

8131 

8192 

Dry Eye Curly Coat Syndrome (CCS) + 

Episodic Falling 


Episodic Falling (EF) 


Exercise Induced Collapse (EIC) 

(Boykin Spaniel, Chesapeake Bay Retriever, Curly Coated Retriever, German 

Wirehaired Pointer, Labrador Retriever, Pembroke Welsh Corgi) 

Factor VII Deficiency 

(Airedale Terrier, Alaskan Klee Kai, Beagle, Giant Schnauzer, Scottish Deerhound) 

Familial Nephropathy* (FN) 

(English Cocker Spaniel) 

Familial Nephropathy (FN) 

(English Springer Spaniel, Samoyed) 

8016 

Fucosidosis 

(English Springer Spaniel) 

8007 

8156 

Globoid Cell Leucodystrophy / Krabbe-disease 

(Cairn Terrier, West Highland White Terrier) 

Glycogen Storage Disease (GSDIIIa) 

(Curly Coated Retriever) 

8066 8135 

8098 

8232 

8221 

8157 

(Husky, Portuguese Waterdog) 

Grey Collie Syndrome (Canine Cyclic Neutropenia) 

(Collie) 

Hemophilia A (Factor VIII deficiency) 

(Bichon Havanese) 

Hemophilia B (Factor IX deficiency) 

(Rhodesian Ridgeback) 

Hereditary Cataract (HSF4) 

Hereditary Myopathy (CNM) 

(Labrador Retriever) 

Hereditary Nasal Parakeratosis (HNPK)* 


Hereditary Necrotizing Myelopathy (HNM)* 

(Dutch Kooiker) 

Hereditary Neuropathy (GHN) 

(Greyhound) 

Hyperuricosuria (SLC) 

(All breeds) 

(Lagotto Romagnolo) 

8197 

Malignant Hyperthermia (MH) 

(All breeds) 

MDR1 Gene Defect* (Ivermectin Sensitivity) 

(American White Shepherd, Australian Shepherd, Bobtail, Border Collie, Elo, German 

Shepherd, Longhaired Whippet, Mc Nab, Rough,- Smooth Collie, Shetland Sheepdog, 

Silken Windhound, Waeller, Weißer Schweizer Schäferhund) 

Mucopolysaccharidosis Type VII (MPS) 

(German Shepherd) 

Muscular Dystrophy 

(Cavalier King Charles Spaniel, Golden Retriever) 

Musladin-Lueke Syndrome (MLS) 

(Beagle) 

8220 

Myostation mutation("Bully-Gen") 

(Whippet) 

8022 

GM1-Gangliosidosis crd-PRA 

(Australian Shepherd, Wäller) 

8073 

8421 

8421 

8179 

8154 

8437 

8198 

8204 

Ichthyosis 

(Golden Retriever) 

Junctional Epidermolysis Bullosa (JEB) 

(German Shorthaired Pointer) 

Juvenile Dilatative Cardiomyopathy (JDCM)* 

(Portuguese Waterdog) 

8459 

8125 

Juvenile Epilepsy* 

Juvenile Renale Dysplasia (JRD)* 


L-2-Hydroxyglutaric Aciduria (L-2-HGA) 

(Staffordshire Bull Terrier) 

Myotonia Congenita 

(Miniature Schnauzer) 

Narcolepsy 

(Doberman Pinscher, Labrador Retriever) 

Necrotizing Meningoencephalitis (MNE) 

(Pug) 

Neonatal Cerebellar Abiotrophy (NCCD) 

(Beagle) 

Neonatal Encephalopathy (NEWS) 

(Standard Poodle) 

Neuronal Ceroid Lipofuscinosis (NCL) 

(American Bulldog, Australian Shepherd, Border Collie, Dachshund, English Setter, 

Tibet Terrier) 

Night Blindness (CSNB) 

(Briard) 

Osteogenesis imperfecta 

(Shorthaired, Wirehaired Dachshund) 

8017 

Phosphofructokinase Deficiency (PFKD) 

(American Cocker Spaniel, English Springer Spaniel, Whippet, Wachtelhund) 

Polyneuropathie (AMPN) 

(Alaskan Malamute) 

Primary Lens Luxation (PLL) 

(Chinese Crested, Jack Russell Terrier, Jagd Terrier, Lancashire Heeler, Miniature Bull 

Terrier, Parson Russell Terrier, Patterdale Terrier, Rat Terrier, Sealyham Terrier, Tibet 

Terrier, Toy Fox Terrier, Volpino Italiano, Welsh Terrier) 

Primary Open Angle Glaucoma (POAG) 

(Beagle) 

Retinal Atrophy 

(Standard Wirehaired Dachshund) 

8002 

Dominant Form of PRA 

(Bull Mastiff, English Mastiff) 

8451 

Generalized PRA 

(Schapendoes) 

8200 

GR_PRA1 

(Golden Retriever) 

prcd-PRA 

8094 

performed by OPTIGEN* 

8127 

performed by partnerlab* 

(American Cocker Spaniel, American Eskimo Dog, Australian Cattle Dog, Australian 

Shepherd, Australian Stumpy Tail Cattle Dog, Chesapeake Bay Retriever, 

Chinese Crested, Cockapoo, Dwarf Poodle, English Cocker Spaniel, Entlebucher 

Mountaindog, Finnish Lapphund, Golden Doodle, Golden Retriever, Kuvasz, 

Lapponian Herder, Labrador Retriever, Labradoodle, Markiesje, Nova Scotia Duck 

Tolling Retriever, 

Norwegian Elkhound, Portuguese Waterdog, Swedish Lapphund, Toy Poodle, Spanish 

Water Dog, Silky Terrier, Yorkshire Terrier) 

rcd 1-PRA 

(Irish Setter, Irish Red and White Setter) 

8002 

rcd 1a-PRA 

(Sloughi) 

rcd 2-PRA* OPTIGEN 

(Collie) 

rcd 3-PRA 

(Welsh Corgi) 

rcd 4-PRA 

(Gordon Setter, Irish Setter, Tibet Terrier) 

In order to allow the breeding club discount please enclose a breeding club membership confirmation to each sample 

submission. The invoice can not be altered subsequently. 

D000000000001D 

000000000001 

8062 

8032 

8069 

8068 

8411 

8067 

8429 

8457 

8155 

8075 

8011 

8215 

8479 

8226 

8452 

8002 

8153 

8002 

8435

Dog 


8104 

8015 

8150 

8191 

8143 

Pyruvat Dehydrogenase Phosphatase 1 Deficiency 

(Clumber, Sussex-Spaniel) 

Pyruvatkinase Deficiency (PK Deficiency) 

(Basenji, Beagle, Labrador Retriever, Pug, Westhighland White Terrier) 

Retinal Dysplasia* (OSD) OPTIGEN 

(Labrador Retriever, Samoyed) 

Startle Disease 

(Irish Wolfhound) 

Trapped Neutrophil Syndrome (TNS) 

(Border Collie) 

In order to allow the breeding club discount please enclose a breeding club membership confirmation to each 

sample submission. The invoice can not be altered subsequently. 

D000000000002D 

000000000002 

von-Willebrand-Disease 

von-Willebrand-Disease 

(Dutch Kooiker) 

von-Willebrand Disease Type 1 

(Bernese Mountain Dog, Coton de Tulear, Doberman, Drentsche Patrijshond, German 

Pinscher, Labradoodle, Manchester Terrier, Kerry Blue Terrier, Papillon, Pembroke 

Welsh Corgi, Poodle, Stabyhound) 


(German Shorthaired Pointer, German Wirehaired Pointer) 


(Scotch Terrier, Sheltie) 

Dwarfism (Skeletal Dysplasia 2) 


Dwarfism 

(Czechoslovakian Wolfdog, German Shepherd, Saarloos Wolfdog) 

Coat Colours / Coat Length (Breeds upon request) (Sample Material: 0,5 - 1 ml EDTA-blood, Buccal Swabs) 

8144 

8023 

8196 

8136 

8018 

8458 

8146 

A-Locus (Agouti) 

B-Locus (Coat Colour Brown) 

Curly 

D-Locus (Dilution) 

E-Locus 

(Coat Colours Yellow, Lemon, Red, Cream, Apricot) 

EG-locus domino/grizzle 

Coat Length 

Improper Coat 

(Portuguese Waterdog) 

K-Locus 

K-Lokus* (brindle) 

Sable* 

(Afghan Hound, Saluki) (English Cocker Spaniel) 

EM-Locus (Melanistic Mask Allele) 

DNA-Profile / Parentage** (Sample Material: 0,5 - 1 ml EDTA-blood) 

8109 

8107 

Parentage verification 

DNA-Profile (each parent) 

(Identity confirmation) 

Furnishing 

S-Locus* 

Likelihood ratio calculation (incl. DNA-Profile) 


Breed Analysis (DNA-Profile + assignment) 


For parentage evaluation DNA profiles of each parent is needed. 

If only sample material from one parent is available we would like you to contact us prior to submitting the samples. 

8210 

8119 

8014 

8233 

8456 

8142 

8195 

8124 

8405 

8145 

8185 

8180 

8438 

8212 

8211

Cat 


8002 

(Korat, Oriental Shorthair, Siamese) 

8149 

Gangliosidosis (GM2) 

(Burmese) (Persian and related breeds) 

8113 8117 

8465 

8080 

Glycogen Storage Disease (GSD) Type IV 

(Norwegian Forest Cat) 

Head Defect* 

(Burmese) 

Hypertrophic Cardiomyopathy (HCM) 

Mutation 1 Meurs (G --> C)(Maine Coon) 

8116 

Coat Colours / Coat Length (Sample Material: 0,5 - 1 ml EDTA-blood, Buccal Swabs) 

8090 

Coat Colour Variant Agouti 

(All breeds) 

8086 

Coat Colour Variant Burmese 

(All breeds) 

8085 

Coat Colour Variant Siamese (Point) 

(All breeds except Bengal) 

(All breeds) 

8099 8147 

Coat Colour Variant Dilution 

(All breeds) 

Blood Group Testing 

8121 

Gangliosidosis (GM 1/GM 2) 

Hypertrophic Cardiomyopathy (HCM) 

(Ragdoll) 

Genetical Blood Group Testing 

(All breeds except Turkish Angora, Ragdoll, Sibirian, Neva Masquerade, European 

Shorthair) 

Additional genetic testing of the blood group is helpful prior to selection of mating partners especially in case of the queen being group 

A or AB due to the fact that group A animals can carry and pass on the recessive b gene for group B. 

SAMPLE MATERIAL: EDTA BLOOD OR SWAB 

DNA-Profile / Parentage** (Sample Material: 0,5 - 1 ml EDTA-blood) 

Parentage verification 

Breed Analysis (DNA-Profile + assignment) 


8453 

Hypokalemia* 

(Burmese) 

8013 

Polycystic Kidney Disease (PKD) 

Progressive Retinal Atrophy (rdAc-PRA) 

(Abyssinian, American Curl/Wirehair, Balinese, Bengal, Colorpoint Shorthair, Cornish 

Rex, Javanese, Munchkin, Oriental Shorthair, Singapura, Siamese, Somali, Tonkinese) 

Pyruvatkinase Deficiency (PK) 

(Abyssinian, Bengal, Domestic Shorthair and Longhair, Egyptian Mau, La Perm, 

Occicat, Maine Coon, Norwegian Forest, Savannah, Siberian, Singapura, Somali) 

Feline Spinal Muscular Atrophy (SMA) 

(Maine Coon) 

Coat Colour Amber 

(Norwegian Forest Cat) 

Coat Colour Chocolate 

(All breeds) 

8083 

Coat Colour Cinnamon 

Coat Length 

(All breeds) 

Serological Blood Group Testing 

(only EDTA Blood) 

(All breeds) 

Serological evaluation of the blood group is needed to differentiate between groups A, B and AB. Prior to any blood transfusion both 

donor and recipient should be tested to avoid incompatibilities. SAMPLE MATERIAL: EDTA BLOOD 

8109 

8211 

DNA-Profile (each parent) 

For parentage evaluation DNA profiles of each parent is needed. 

If only sample material from one parent is available we would like you to contact us prior to submitting the samples. 

* Partnerlab 

**Additional Information DNA-Profile: 

Please send in samples from both parents even if only the parentage of the Father has to be verified. 

All animals with possible parenthood should be tested. 

Sampling should be performed by an officially appointed person if the result is going to be part of a legal issue. 

1) The identity of the animal needs to be confirmed by a veterinarian (specified by Microchip-No, Tattoo-No.) 

2) Certificates are not issued for partner laboratory services and genetic blood group testing of cats 

3) Certificates are included in the services of DNA-profile and parentage testing 

In order to allow the breeding club discount please enclose a breeding club member confirmation to each sample 

submission. The invoice will not be altered subsequently. 

Supply order: Cytobrushes (DNA-tests) 

Submission forms - GENETICS 

D000000000003D 

000000000003 

55 

Business Conditions: 

8015 

8123 

8170 

8084 

618 

8107 

All statements according to our conditions see (www.laboklin.com) / All terms and prices are subject to changes. 

* = partnerlab 

64 

015.005 12/11

Submission form Genetics Dog/Cat - Laboklin

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