MANOR COURT VETERINARY CENTRE

                     RACING PIGEON LABORATORY REQUEST FORM

                                                                                       REF No. ……...............….

 Name…………………………..……….………………………………..…….……………………………

Address………………………………………………………………..………………………….…………

e-mail address …………………………….………………………..………………..………………….. 

Contact  Tel No ......................................................................................................  

Has another veterinary surgeon been consulted    Yes / No 

If Yes please please give name and contact details ………….………………………………. 

 Routine samples  Yes / No       Disease investigation  Yes /No           please specify below

       Sample submitted:- Pooled faeces/Individual faeces/Throat swab/Other……..........………..

 If submitting a dead bird please fill in a post mortem request form as well.

 Date sample collected………………………….

 Tests requested   (delete as applicable) 

 Worm egg and Coccidia oocysts count   Yes / No : Wet smear for Canker  (Fresh throat swab) Yes / No 

 Culture for salmonella / other bacteria  Yes / No  Other tests required  ..................................

.......................................................................................................................

Details of any treatment already given

 Signed……………………………...............................…..…………………          Date……….....……………….