PLEASE SEND WITH THE SAMPLE: - Requisition Form (REQUIRED) Available in two formats, as a PDF document and as a MS Word document. Please fill in BOTH PAGES of the requisition form completely.
| Collagen Diagnostic Laboratory | Select Format | | Requisition Form | MS Word
 | PDF
 |
- Repository Consent Form (OPTIONAL)
- What is the CDL Repository Consent?
- You are asked to give or deny permission to save and store the cells or DNA sent for laboratory testing to be used for research
- You are asked to give or deny permission to be contacted by the lab in the future to update medical information or request additional information
- Choose
- ADULT consent: Patient is 18 years of age or older
- PARENT consent: Any patient under 18 years of age
- MINOR consent: Patient age 12-17 (must accompany PARENT consent)
- MINOR CHILD consent: Patient age 7-12 (must accompany PARENT consent)
- MINOR SMALL CHILD consent: Patient < 7 years (must accompany PARENT consent)
- PROXY consent: Patient/Relative is deceased (next of kin)
- Print a copy for the patient to keep
- Send original consent with the sample
INTERNATIONAL SAMPLES Sample Shipping: An import permit is not required by the USDA in order to ship a sample to the CDL from outside the continental United States. However, to ensure that the sample arrives quickly, you may want to attach a note to the outside of the package to explain this. In the note indicate that cells or DNA are enclosed, that they are for clinical diagnostic testing and that have no commercial value. You may refer to our CUSTOMS FORM for a template. International Billing: Pre-payment for international samples is required. Click HERE for a wire transfer payment instructions. Please contact Barbara Kovacich at kovacich@u.washington.edu with any questions. Send to: Peter H. Byers, MD
Department of Pathology
Room D-518
Health Sciences Building
University of Washington
1959 NE Pacific St.
Seattle, WA 98195
Ph: 206.543.0459 | 
