WvW Diagnostics | Sample submission

Owner and practice details

Enter the owner and submitting veterinarian/practice details exactly as they should appear on the report.

Owner details

Name & surnameFarm nameCell numberEmail addressAddress

Sender details

Name & surnamePractice nameCell numberEmail addressAddress

Person responsible for account

Owner Sender

VAT number

Results to be shared with

Owner Sender

Sample information

Complete the sample information for this submission, then select the tests required.

Species

Bovine Ovine Caprine Other

Clinical history (if applicable)

Tests required

Select all tests requested. Brucellosis RBT is referred to an accredited laboratory temporarily, so your practice does not need to split the submission.

Other test

Brucella submission details

Complete the details for the controlled BR5 document. Owner, sender, species, collection date and animal IDs are taken from the other sections of this form. Fields marked “if available”, “if assigned” or “if allocated” may be left blank.

For coordinates, enter a positive longitude for East and a negative latitude for South. For example: 28.400000 and -24.700000.

Farm / diptank number (if assigned)Local municipal areaDistrictCA file reference number (if allocated)Longitude (East, decimal degrees)Latitude (South, decimal degrees)State veterinary officeState vet telephone numberState vet email addressState vet fax number (if available)Owner fax number (if available)Sender fax number (if available)Reason for testingType of herd

Brucella vaccination history

Select the vaccination status, then record the vaccine used for calfhood / heifer vaccination and adult vaccination separately. Choose S19 (Strain 19), RB51, both, or Not applicable for each category.

Vaccination history

Animal ID list

Select the tests required above, then enter every animal or sample included in this submission.

Sample number	Animal ID	Breed	Gender	Age

Add every sample or animal included in this submission.

How will the samples reach WvW Diagnostics?

1. Pathteq collection from my practice RecommendedWvW will arrange collection. 2. Deliver to Pathteq Modimolle depotDrop the parcel off yourself, or arrange your own delivery. WvW will prepare the Pathteq waybill. 3. Not applicable — samples will be handed directly to WvW

Electronic acknowledgement

Full name of person completing this formI agree to information being shared where required by law.
This form must be completed in full with every submission. Incomplete or unsigned forms may delay testing and result issuing. WvW Diagnostics may refuse unsuitable samples, refer samples to other laboratories where appropriate, and notify the owner/sender of associated costs.

Electronic signature

Sign inside the box using your finger or mouse. This signature is placed on the controlled WvW submission PDF.

Signature required

Submission received

Sample submission