Berner-Garde/MSU DNA/Tissue Repository
Online Sample Submission Form
Please submit this form only when samples have been collected and are ready for shipment. If you and/or your dog are already in the Berner-Garde Database, the information can be populated in the form very easily if you know the Berner-Garde ID's for your records. To do this, type the ID into the appropriate box in the form then click on the Populate button.

After you are done entering data for your submission, click on the button at the bottom of the page to send your information to the repository. You will then be given an opportunity to print a copy of your data to send in with your sample(s). PLEASE include a copy of this filled out form with your sample to insure the submission is recorded properly. Additionally, refer to the shipping information available on the MSU web site (click here) to make sure your submission arrives in good condition.
Sample(s) Being Submitted
For detailed instructions on sample submission or to request supplies, please visit
http://old.cvm.msu.edu/research/berner/ or email berners@cvm.msu.edu
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Notes: 
Fresh-frozen tumors MUST be shipped to the repository on DRY ICE by OVERNIGHT delivery. Shipping on regular ice or
"blue ice packs" (used in coolers) will not keep the tissue frozen and will result in unusable samples.
  send these specimens directly to:
MSU Diagnostic Center for Population and Animal Health
The fee for Pathology diagnostic services is generally billed by your veterinarian (if they submit) or billed directly to you (if
you subit). Turn around time is generally 3-5 days for results. The cost for this diagnostic service is not covered by the
repository grant.
Please note that the Repository cannot acquire tumor tissue once it is submitted for diagnostic services due to regulations. Tumors intended for the repository will need to be submitted separately, and shipped to the repository address.
 
If you are submittion the tumor for diagnostic pathology testing to a lab other than the Diagnostic Center for Populatiuon and
Animal Health at Michigan State University, please be sure you or your veterinarian sends us a copy of the final report. 
Dog Information Berner-Garde Dog ID:     
Call Name:    
Registered Name: 
Registration #:  Gender: 
Date of Birth:  Date of Death: 
Sire Name: 
Dam Name: 
Owner Information Berner-Garde People ID:     
First Name:  MI: Last Name: 
Street Address: 
City:  State: 
Postal Code:  Country: 
Phone Number: 
Email Address: 
Breeder Information Berner-Garde People ID:     
First Name:  MI: Last Name: 
Street Address: 
City:  State: 
Postal Code:  Country: 
Phone Number: 
Email Address: 
Veterinarian Information Berner-Garde Vet ID:     
First Name:  MI: Last Name: 
Hospital/Clinic: 
Street Address: 
City:  State: 
Postal Code:  Country: 
Phone Number: 
Email Address: 
Brief Medical History Dog experiencing medical problems?  
Please list diagnosis or medical history:
Pathology Report(s)
Please attach any relevant pathology or diagnostic reports that are available now and please forward any as they become available.
Feel free to add additional pages.
Additional Comments
Release Agreement
The submitting party agrees to relinquish ownership of these samples to the Repository. Any future use or distribution of this sample will be within the sole direction and authority of the Repository. All submitted specimens will be given an anonymous number, which will be used to distribute samples to researchers in a blind format that maintains the anonymity of the dog and owner identities. If a researcher requires further information regarding and individual dog, that information will be provided through Berner-Garde and its approved designees. Publication of research results will not include information specific to any dog or owner. The submitting party agrees to participate in the open Berner-Garde database, which includes routine medical history of the dog, pedigree information and the data submitted above. The submitting party further understands that research findings using Repository samples will remain confidential.

I hereby donate, assign and transfer the sample(s) of the dog named above to the Berner-Garde-MSU DNA and Tissue Repository (Repository) for research purposes. I have read the information provided above and have had opportunity to ask questions regarding the procedures involved. I am the owner or agent of the dog named in the submission form and have authority to execute this release. Clicking the button below, indicates that I voluntarily donate this dog’s tissue, blood or cheek sample to the Repository as indicated by checking the appropriate sample types listed above.
 
Note that you will be given an opportunity to print the submission confirmation after clicking the Submit button.