ORDER FORM - GENETIC TESTING / CAT

VETERINARY CLINIC OWNER / BREEDER Vet: Name: Clinic: Street: Street: City: City: Post code: Post code: Country: Country: E-mail (mandatory): E-mail: Phone: Phone:

Payment method: bank transfer PayPal / credit card Invoice to: clinic owner Owner’s signature:

ANIMAL DATA Sample number (do not fill, for laboratory use only)

Species: dog cat

Sex: male female Sample collection date:

Sample type: blood buccal swab other: Name:

Breed:

Date of birth:

Chip number:

Pedigree number:

Tatoo number:

IDENTITY CONFORMATION (NON-COMPULSORY)

NOTE: Some breeding organizations require conformation of animal identity by veterinarian or other independent person when taking samples. Samples without identity conformation might not be recognized by local breeding organization.

I declare that I checked animal identity and confirmed that the sample is from animal specified on this order form.

VET‘S SIGNITURE & STAMP:

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EVG d.o.o. - Taborska ul. 8 - 2000 Maribor - Slovenija - Tel. +38640566273 - E-mail: [email protected] - web: www.eurovetgene.com

1 GENETIC DISEASES - DOG AD - PRA (, ) GRMD ()

AI/FEH (Parson Russ. Ter., Akita, Ital. , Samoyed) GSDII (Finnish, , )

AMPN (Alaskan Malamute) GSDIIIa (Curly Coated Retriever)

AMS (several breeds) HEREDITARY CATARACT - HSF4 (several breeds)

BAS - PRA (Basenji) HN (Samoyed)

BNAT (Coton de Tulear) HNPK* ()

CDPA/CDDY – IVDD (all breeds) HUU (all breeds)

CEA (several breeds) ICT - A (Golden retriever)

CHG (Toy Fox , ) ICT (American )

CJM ( Dog) IGS (Border , )

CKCSID (Cavalier ) IMGD (Great Dane)

CLAD (Irish Setter) IPD (Collie)

CMO (West Highland White, Scottish and ) JLPP (, Rotweiller)

CMR1 (several breeds) JME (Rhodesian Ridgeback)

CMR2 (Coton de Tulear) JUVENILE EPILEPSY (Lagotto Romagnolo)

CMS (Labrador retriever, Danish Pointing Dog) L-2-HGA (Staffordshire )

CMSD (Chinese Crested dog, ) LAD (Bullterier)

CMT - CHARCOT-MARIE-TOOTH (Miniature ) LOA (, )

CNGA1- PRA () LSD (Lagotto Romagnolo)

CNM (Labrador Retriever) MC (Miniature Schnauzer)

COMMA DEFECT (Miniature Schnauzer) MCD (Labrador retriever, Labradoodle)

CORD1 - PRA (several breeds) MD (Cavalier King Charles Spaniel, Landseer)

CORD2 - PRA (Standard wire-haired dachshund) MDR1 (several breeds)

CRD1- PRA (American Staffordshire, Am. Pit Bull Terrier) MH (all breeds)

CSNB () MLS (Beagle)

CYSTINURIA TYPE I (Newfoundland and Landseer) MPS VII ()

CYSTINURIA TYPE IIB (Miniature Pinscher) MYOSTATIN DEFICIENCY - BULLY ()

CYSTINURIA TYPE III (Bulldog, French bulldog, Mastif) NAD (, Papillon)

DCM (Doberman Pinscher, Schnauzer) NARCOLEPSY (Labrador Retriever, Doberman Pinscher)

DM* (all breeds) NCCD (Beagle)

DMS (Shetland Sheepdog, Collie) NCL 1 (Dachshund)

ED/SFS (Chesapeake Bay Retriever) NCL 10 (American Bulldog)

EF* (Cavalier King Charles Spaniel) NCL 2 (Dachshund)

EIC (several breeds) NCL 4A / Cerebellar Ataxia (several breeds)

FACTOR VII DEFICIENCY (several breeds) NCL 5 ()

FANCONI SYNDROME (Basenji) NCL 6 ()

FN (English , ) NCL 8 (, Irish Setter, )

FUCOSIDOSIS (English Springer Spaniel) NCL A ()

HEREDITARY DEAFNESS (Doberman Pinscher) NCL GR (Golden Retriever)

GCS (, ) NE (Standard Poodle)

GG (Border Collie) OI (Dachshund, Golden Retriever)

GLD (West Highland White Terrier, Cairn Terrier, Irish Setter) P2Y12 (Greater Swiss Mountain Dog)

GM1 (Portugese Waterdog, Siberian Husky, Shiba inu) PAP - PRA1 (Papillon)

GM2 (Toy Poodle, Shiba Inu) PCD (Bobtail)

GR - PRA1 (Golden Retriever) PDP1 (,)

GR - PRA2 (Golden Retriever) PFKD (several breeds)

2 GENETIC DISEASES - DOG DNA TEST PACKAGES - DOG

PH I (Coton de Tulear) Package - Border Collie (CEA, IGS, MDR1, SN, NCL, TNS, RAINE, GG)

PITUITARY DWARFISM (several breeds) Package - Austral. Shep. (CEA, DM*, HSF4, MDR1, BOB TAIL, NCL6, PRCD, CMR1)

PK (Beagle, Labrador retriever, Pug) Package - Labrad. Ret. 1 (EIC, PRCD, HNPK*, NARCO., CNM, SD2, RD/OSD)

PKD (Bull Terrier) Package - Labrador Retriever 2 (EIC, PRCD, HNPK*)

PLL (several breeds) Package - Golden Ret. 1 (PRCD, GR-PRA1, GR-PRA2, ICT-A, GRMD, NCL, OI)

PLN (Soft Coated Wheaten Terrier) Package - Golden Retriever 2 (PRCD, GR-PRA1, GR-PRA2)

POAG (Beagle) Package - Beagle (IGS, MLS, FVII, PK, NCCD, POAG)

POAG/PLL (Shar-Pei) Package - Jack / Parson Russel Terrier (LOA, SCA, PLL)

Polyneuropathy (Greyhound) Package - Lagotto Romagnollo (JE, LSD, FURNISHING)

PRA B1 (Miniature Schnauzer) Package - Poodle (DM*, RCD4, NE, PRCD, vWD1)

PRA - PRCD (several breeds) Package - Cavalier King Charles Spaniel (EFS*, CKCSID)

PRA - RCD1 (Irish Setter) Package - Collie (CEA, DM*, GCS, MDR1, RCD2, HUU, IPD)

PRA - RCD1a (Sloughi) Package - Long-haired Whippet (CEA, MDR, DM*)

PRA - RCD2 (Rough Collie, Smooth Collie) Package - Papillon (NAD, PAP-PRA1, vWD1)

PRA - RCD3 (several breeds) Package - Sheltie (CEA, MDR1, DM*, CNGA1-PRA, vWD3)

PRA - RCD4 (several breeds) Package - Sheltie XL (CEA, MDR1, DM*, CNGA1-PRA, vWD3, DMS)

RAINE SYNDROME (Border Collie) Package - Coton de Tulear (CMR2, BNAt, PH1, vWD1, PRCD, CDPA/CDDY)

RCND ( Dog) Package - Stafordshire Bulterier (HSF4, L2HGA)

RD/OSD (Labrador retriever) Package - (FN, PRCD, AMS)

SCA (Jack Russell Terrier, Parson Russell Terrier) Package - English Spring. Spaniel (CORD1, FUCOSID., PFKD, FN, AMS)

SD2 – Dwarfism (Labrador retriever) Package - Tibetan Terrier (NCL, RCD4, PLL)

SDCA1 (Belgian Shepherd) Package - Landseer (CYSTINURIA, MD, DM*, D LOCUS)

SDCA2 (Belgian Shepherd) Package - French Buldog (HSF4, CMR1, DM*, HUU, CYSTINURIA TYPE 3)

SN (Border Collie) Package - Chin. Crested (CMSD, PRA-PRCD, PRA-RCD3, PLL, vWD2, DM*)

SPAID (Shar Pei) Package - Czechoslovakian Wolfdog (PIT. DWARFISM, DM*, FGF5)

TNS (Border Collie) Package - Austral. Cattle Dog (PRA-PRCD, PRA-RCD4, PLL, NCL5, DM*)

VDEGS (Wire ) Package - Giant Schnauzer (DCM, PRA-PRCD, FVII)

vWDI (several breeds) Package - Spanish Water Dog (PRCD, NAD, DM*, BOB TAIL)

vWDII (several breeds) Package – German Shepherd Dog (DM*, MDR1, HUU, FGF5, PIT. DW.)

vWDIII (Scotch Terrier, Shetland Sheepdog, Dutch Koiker) Package – Dachshund (CDPA/CDDY, CORD1, CORD2 , NCL1, NCL2, OI)

XL - PRA (Siberian Husky, Samoyed) Package – Doberman (DM*, DCM, VWD1, B LOCUS, D LOCUS, HER. DEAF.)

COAT COLOUR AND QUALITY - DOG Package – Irish Setter (CLAD, HUU, NCL8, RCD4, RCD1, VWD1)

E-Locus Package – Mastiff (CMR1, DM*, AD-PRA, HUU, CYSTINURIA TYPE 3)

B-Locus Package – (HUU, LAD, PKD, PLL)

D-Locus Package – - Bobtail (DM*, EIC, MDR, PCD)

K-Locus Package – Rhodesian Ridgeback (DM*, JME, B LOCUS, D LOCUS)

A-Locus Package – Rottweiler (DM*, JLPP, FGF5)

M-Locus () Package – Shiba Inu (GM1, GM2, A LOCUS, E LOCUS)

EM-Locus Package – (VWD1, DM*, CDPA/CCDY, BOB TAIL, RCD3)

S-Locus Package – Whippet (FIIV, MYOSTATIN DEFICIENCY, PFKD)

I-Locus Package – Portuguese Water Dog (PRCD, IMPROPER COAT, GM1)

Furnishing / improper coat (RSPO2) Package – Bull Terrier (LAD, PKD1, HUU)

Short tail – bobtail Package – Basenji (BAS-PRA, FANCONI)

Coat Length (FGF5) Package - Coat color (LOCUS: A, B, D, E, K, S) DNA PROFILE / PARENTAGE - DOG DNA profile (ISAG) * Partner lab

3 GENETIC DISEASES - CAT

PKD (Persian and related breeds)

HCM (Maine Coon, Ragdoll)

4