Veterinary HPAI Sample Kit Request

Veterinary HPAI Sample Kit Request Form

The Oregon Department of Agriculture, in partnership with the Oregon Health Authority will provide sampling kits to veterinarians and veterinary clinics to test pets for Highly Pathogenic Avian Influenza. Kits include a polyester swab, BHI viral transport media (refrigerate upon arrival), and personal protective equipment (2 sets).

1. Veterinarian/Clinic Contact Information

Name

Title

Clinic Name

Street Address

Apt/Suite/Office

City

State

Zip

Email Address

Phone Number

2. Practice Type *This question is required.

Please enter an 'other' value for this selection.

3. Highly Pathogenic Avian Influenza in any species is an immediately reportable disease. Veterinarians must report suspected cases to the Oregon Department of Agriculture by phone (503-986-4711) PRIOR TO submitting samples for laboratory testing. *This question is required.

I agree to report suspect cases prior to submitting samples for testing