Molecular Pathology Core Laboratory

Molecular Pathology Core Laboratory Service Request Form

Please complete the service order form below. We will prepare a quote upon request, before proceeding with your project.

Refer to this page for service rates.

If you have additional questions, email [email protected] or call 401-444-5849.

Requestor Information

First Name

Last Name

Phone Number

Principal Investigator Information

First Name

Last Name

Department/Institution

IRB/IACUC Protocol Number

Approval Letter

Please attach protocol approval letter.

One file only.
512 MB limit.
Allowed types: txt, pdf, doc, docx.

Billing Contact Information

First Name

Last Name

Phone Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Cost Center/PO #

PI Approval

(By signing this form, the PI agrees to take full responsibility for the payment of the service.)

Approval Date

Immunohistochemistry

Antibody:

Manual Staining - Dako EnVision FLEX Kit

Automated Staining - Dako Link48

Automated Staining - Leica Bond RXm

Antibody Optimization

Number of Slides:

Comments/Special Considerations

Molecular Pathology Core Laboratory Service Request Form

Requestor Information

Principal Investigator Information

IRB/IACUC Protocol Number

Billing Contact Information

Cost Center/PO #

PI Approval

Approval Date

Histology and Stains

Immunohistochemistry

Tissue Microarrays (TMAS)

Whole Slide Scanning