Anatomic Pathology Research Services

Technical
Component

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Anatomic Pathology Research Services Request Form

General Instructions:

Fill out the form below or print and fill out.
Complete the top portion of the form.
** Bring form and specimen(s) to the Anatomical Pathology laboratory located at:

Gateway Building - MCV campus
1200 E. Marshall St, 6^th floor
Richmond, VA 23298
Phone: 804-828-9739
Fax: 804-828-8733

** "Please call prior to bringing samples to lab to ensure that someone is available to accept the specimens. Thank You."

Special Instructions for Immunohistochemistry:
Basic Guidelines and Compatibility Information

Date:

Address/PO Box:

Contact Person:

Dept/Division:

Principal Investigator:

Fiscal Administrator:

Phone #:

Budget Code/Grant #:

Pager #:

Email:

Services Requested:
If you are interested in any of the services, enter the quantity in the boxes.
Processing/embedded block (paraffin block)
Frozen section
Unstained Slide (blank)
Hematoxylin and Eosin stain (Includes unstained slide)
Immunohistochemical stain with antibody from researcher
(Antibody is supplied by requestor)
Immunohistochemical stain using AP lab antibody
Immunohistochemical antibody procedure workup
Immunofluorescence stain
Histological Special stains
Archival services
Control slides
Slide Tray

For Specific Tests and/or Materials, please provide information:

For prices please contact:
Jorge Almenara Ph.D.
Gateway Building, 6th Floor, Rm 6-213
Phone# (804) 628-2949