Veterinary Sample Kit Request

Veterinary Sample Kit Request Form

The Oregon Department of Agriculture, will provide sampling kits to veterinarians and veterinary clinics to test pets for high consequence reportable diseases such as Highly Pathogenic Avian Influenza (HPAI) and New World Screwworm (NWS). Please use this form to request kits.

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 and New World Screwworm in any species are immediately reportable diseases. 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