Milk Submission Form

csu.cvmbs.colostate.edu

Milk Submission Form

www.dlab.colostate.eduPhone: 970-297-1281Fax: 970-297-0320Milk SampleSubmissionFormOFFICE USE ONLYOpened By:DHL USPS FX Courier OtherFrozen Dry Ice Ice Pack RT OtherComments:FedEx/UPS/Drop Off Address:USPS Only Address:CSU Veterinary Diagnostic LaboratoryCSU Veterinary Diagnostic Laboratory200 West Lake Street 300 West Drake Road1644 Campus Delivery Fort Collins, CO 80526Fort Collins, CO 80523-1644Veterinarian:____________________________________Clinic:__________________________________________Address:_______________________________________City:________________ State:______ Zip:___________Phone:_________________________________________Fax:Email:____________________Owner/Producer:___________________________________Business/Premise ID:________________________________Address:__________________________________________City: State: Zip:____________________________________Phone:___________________________________________Fax:Email:____________________Person to be Billed: Veterinarian Owner/Producer Report Results To: Owner/Producer VeterinarianSend Results By: Fax Email PhoneSpecies Bovine Caprine OvineIndividual & Composite Mastitis TestingBacteria ID & Mycoplasma:______________________Contagious ID (aureus, ag, Myco):_________________Mycoplasma Only:_____________________________Bacteria ID Only:______________________________Mycoplasma PCR: _____________________________If multiple samples and tests requested specify on animalsubmission formMilk Quality Testing (Composite samples)Coliform Count(CC) _________________________Standard Plate Count (SPC)______________________Laboratory Pasteurized Count (LPC)_______________Preliminary Incubation (PI)______________________Milk Quality Screen (CC, SPC,LPC,PI)_______________If multiple samples and tests requested specify on animalsubmission formRaw Milk TestingE. coli 0157:H7 (25mL milk):___________________________Salmonella(25mL milk) :______________________________Campylobacter(jejuni, coli, lari)(50mL milk):______________Listeria monocytogenes (25mL milk): ___________________Raw Milk Panel (SPC, CC, Salmonella, E.coli 0157:H7)(60mL milk) __________________________________________Q-Fever Elisa:______________________________________If multiple samples and tests requested specify on animalsubmission formBovine Pregnancy Test & Charm Antibiotic ResidueBovine Pregnancy Test(Blood/Milk)____________Caprine Pregnancy Test(Milk Only)____________Beta-Lactam______________________________Tetracycline______________________________Sulfonamides_____________________________Enrofoxacin, ______________________________Flunixin & Beta-Lactam_____________________Alfatoxin_________________________________If multiple samples and tests requested specify on animalsubmission form** For procedures on proper milk sample collection refer to: http://www.cvmbs.colostate.edu/ilm/proinfo/cdn/2001articles/CDNsept01insert.pdf** CSU also offers a courier service to the Fort Collins area if you’re not in the Fort Collins area and are interested in a courier service otherarrangements may be able to be made depending on sample volume, amount and location. If you are planning to use FedEx for a delivery serviceyou may also want to contact us for information on how we may be able to reduce your shipping cost


www.dlab.colostate.eduPhone: 970-297-1281Fax: 970-297-0320MilkMultipleAnimalSubmissionFormOFFICE USE ONLYOpened By:DHL USPS FX Courier OtherFrozen Dry Ice Ice Pack RT OtherComments:12Animal Name/Number/ID Breed Collection Date Test Requested34567891011121314151617181920

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