Submission form Genetics Customer-No. / Barcode LABOR FÜR KLINISCHE DIAGNOSTIK GMBH & CO. KG PB 1810 DE-97668 Bad Kissingen Tel +49 971 72020 Fax +49 971 68546 Business Hours: Mon - Fri: 9:00 - 18:00 h, Sat: 9:00 - 13:00 h

Clinic address: Owner: Invoice to: (Stamp or block letters) (Block letters only, please) Veterinarian Name: ______Owner

First name:______

Date of______birth: ______(If the invoice should be sent to the owner or submitter, please (Owners signature for direct include their complete address and signature ) invoicing) Street: ______VAT-No.: ______Please note: Zipcode/city: Address for invoicing and ______signee must be identical Fax / e-Mail: ______Fax/email:______Date/Signature:______Courier Tel.: ______Notification: Email Fax Mail Report copy to owner

8105 Certificate

1) The sample has to be collected by a veterinarian or an impartial person. 2) The identity of the animal must be specified by Microchip-No., Tattoo-No. and/or Pedigree-No. 3) Certificates are included in the services of DNA-profile and parentage testing; No certificates are provided for partnerlaboratory services.

I have checked the animals identity and confirm that samples are taken from the animals listed below.

Name ______veterinarian: ______Signature / Stamp______veterinarian: ______

Patient-ID:______Date of sampling:______

Please note: Indication of breed is mandatory! (Please complete using capital letters)

Animal 1 (previous result-number, if known: ______- __ - ______)

Sample: 0.5 - 1 ml EDTA-blood 2x buccal swab blood card Sex: female male

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.: Sample______label:

Animal 2 (previous result-number, if known: ______- __ - ______)

Sample: 0.5 - 1 ml EDTA-blood 2x buccal swab blood card Sex: female male

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.: Sample______label:

Animal 3 (previous result-number, if known: ______- __ - ______)

Sample: 0.5 - 1 ml EDTA-blood 2x buccal swab blood card Sex: female male

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.: Sample______label:

010110050017 Hereditary diseases € €

8552 8151 Acatalasemia Faktor VII deficiency (Beagle) (Airedale Terrier, , Beagle, , Giant Schnauzer, Scottish 8166 Achromatopsia (day blindness) (ACHM-1) Deerhound, Welsh Springer Spaniel) 8131 (, Labrador Retriever) Familial nephropathy (FN)* 8259 Adult onset neuropathy* (AON) (English Cocker Spaniel, Welsh Springer Spaniel) 8192 (English Cocker Spaniel, Field Spaniel) Familial nephropathy (FN) 8313 Alaskan encephalopathy (AHE) (English Springer Spaniel, Samoyed) 8272 (Husky) Fanconi syndrome* 8479 polyneuropathy (AMPN) (Basenji) 8467 (Alaskan Malamute) Finnish Hound ataxia (FHA) 8601 Alexander disease (AxD) (Finnish Hound, Norbottenspitz) 8016 (Labrador Retriever) Fucosidosis 8303 Amelogenesis imperfecta (AI) (English Springer Spaniel) 8323 (Italian Greyhound) Gallbladder mucoceles 8207 Bardet-Biedl-syndrome (BBS) (American Cocker Spaniel, Cairn Terrier, English Cocker Spaniel, Pomeranian, ) (Puli) 8219 8077 Brachyuria (stumpy tail) Glanzmann Thrombastenia (GT) (, Australian Stumpy Tail Cattle Dog, Austrian Pinscher, (Pyrenean Mountain Dog) 8007 Bourbonnais Pointer, , Brazilian Terrier, Brittany Spaniel, Globoid cell leukodystrophy / Krabbe-disease , Danish/Swedish Farmdog, Jack Russell Terrier, (Cairn Terrier, Irish Setter, West Highland White Terrier) , , , Pyrenean Shepherd, Savoy 8322 Sheepdog, , Spanish Waterdog, , Welsh Corgi) Glycogen storage disease GSD Ia (Maltese) 8184 8513 C3-Deficiency (C3) Glycogen storage disease GSD II (Pompe disease) (Brittany Spaniel) (, , ) 8012 8156 Canine leukozyte adhesion defiziency (CLAD) Glycogen storage disease GSD IIIa (Irish Setter, Irish Red and White Setter) (Curly Coated Retriever) 8330 8066 Canine multi-focal retinopathy (CMR1/2/3) GM1-Gangliosidosis (GM1) (American Bulldog, Australian Shepherd, Boerboel, Bullmastiff, Cane Corso, Coton de (Portuguese Waterdog, , ) 8208 Tulear, Dogo Canario, Dogue de Bordeaux, English Mastiff, Finnish Lapphund, GM2-Gangliosidosis (Sandhoff-disease) (GM2) Lapponian Herder, Pyrenean Mountain Dog, Swedish Lapphund) (Toy Poodle) 8575 8098 Canine multiple system degeneration (CMSD) Grey syndrome (GCS) (Chinese Crested, Kerry Blue Terrier) (Canine cyclic neutropenia) 8073 Centronuclear myopathy (CNM) (Collie) 8232 (Great Dane, Labrador Retriever) Haemophilia A (Faktor VIII) - deficiency 8314 Cerebral dysfunction (CDFS) (Boxer, German Shepherd, Havanese, ) 8221 (Stabyhoun) Haemophilia B (Faktor IX) - deficiency 8316 Chonrodysplasia (dwarfism) (Lhasa Apso, Rhodesian Ridgeback) 8319 (, Karelian Bear Dog, ) Hemorragic diathesis (Scott syndrome) 8326 Cleft lip/palate and syndactyly (CLPS) (German Shepherd) 8449 (Nova Scotia Duck Tolling Retriever) Hereditary ataxia (HA) 8120 Collie eye anomaly (CEA)* Optigen (Gordon Setter, Old English Sheepdog) 8304 8157 Collie eye anomaly (CEA)* partnerlaboratory Hereditary cataract (HSF4) (Australian Shepherd, , , Boykin Spaniel, , (Australian Shepherd, Wäller) , Longhaired Wippet, Nova Scotia Duck Tolling Retriever, 8576 Rough/, Shetland Sheepdog, Silken Windhound) Hereditary cataract (HSF4)* (Boston Terrier, French Bulldog, Staffordshire Bull Terrier) 8256 8421 Cone degeneration (CD)* Optigen Hereditary nasal parakeratosis (HNPK) (Alaskan Malamute, Australian Shepherd, German Shorthaired Pointer) (Labrador Retriever) 8434 8179 Congenital hypothyroidism with goiter (CHG) Hereditary neuropathy (GHN) (Fox Terrier, French Bulldog, Rat Terrier, Spanish Waterdog, Tenterfield Terrier) (Greyhound) 8317 8154 Congenital Ichthyosis Hyperurikosuria (SLC) (Great Dane) (all breeds) 8206 8443 Congenital myasthenic syndrome (CMS) Hypomyelination / Shaking Puppy Syndrome (SPS) (Jack Russell Terrier, Labrador Retriever, Old Danish Pointing Dog, (English Springer Spaniel, Weimaraner) 8555 Parson Russel Terrier) Ichthyosis 8011 Congenital stationary night blindness (CSNB) (American Bulldog) 8481 () Ichthyosis* 8034 Copper storage disease - Copper toxicosis (Golden Retriever) 8475 (Bedlington Terrier) Imerslund-Gräsbeck syndrome (IGS) 8348 Craniomandibular osteopathy (CMO) (Beagle, Border Collie) 8198 (Cairn Terrier, Scottish Terrier, West Highland White Terrier) Junctional epidermolysis bullosa (JEB) 8013 Cystinuria (German Shorthaired Pointer) 8459 (, English Bulldog, French Bulldog, Labrador Retriever, Landseer, Juvenile epilepsy (JE) Newfoundland, Mastiff, Miniature Pinscher) (Lagotto Romagnolo) 8260 8271 Dandy-Walker-like malformation (DWLM) Juvenile laryngeal paralysis & polyneuropathy (Eurasian) (JLPP) 8485 Degenerative myelopathy (DM) exon 1 (Black Russian Terrier, Rottweiler) 8557 (Bernese Mountain Dog) Juvenile myoclonic epilepsy (JME) 8158 Degenerative myelopathy (DM) exon 2 (Rhodesian Ridgeback) 8125 (all breeds) L-2-hydroxyglutaric aciduria (L-2-HGA) 8472 Digital hyperkeratosis (DH/HFH) (Staffordshire Bull Terrier) 8270 (Dogue de Bordeaux, Irish Terrier, Kromfohrländer) Lagotto storage disease (LSD) 8406 Dry eye curly coat syndrome (CCS) (Lagotto Romagnolo) (Cavalier King Charles Spaniel) 8493 Late onset ataxia (LOA) 8484 Ectodermal dysplasia/Skin fragility syndrome (Jack Russell Terrier, Parson Russel Terrier) 8487 (ED/SFS) Leonberger polyneuropathy 1 (LPN1) (Chesapeake Bay Retriever) (Leonberger) 8311 8327 Epidermolytic hyperkeratosis (EHK) Leukocyte adhesion deficiency III (LAD-III) (Norfolk Terrier) (German Shepherd) 8202 8579 Episodic falling (EF) Lundehund syndrome (LHS) (Cavalier King Charles Spaniel) () 8152 Exercise induced collapse (EIC) (Boykin Spaniel, Chesapeake Bay Retriever, Clumber Spaniel, Curly Coated Retriever,

Labrador Retriever, Old English Sheepdog, , Wirehaired Pointer ) Hereditary diseases € €

8217 8226 Macrothrombocytopenia (MTC) Primary lens luxation (PLL) (Bichon Frise, Boxer, Cairn Terrier, Cavalier King Charles Spaniel, (, American Hairless Terrier, Australian Cattle Dog, Chinese Chihuahua, Cocker Spaniel, Havanese, Jack Russell Terrier, Labrador Crested, Danish Svedish Farmdog, Fox Terrier, Jack Russell Terrier, Jagd Terrier, Retriever, Maltese, Norfolk Terrier, Parson Russell Terrier, Poodle, Shih Lakeland Terrier, Lancashire Heeler, Lucas Terrier, Miniature Bull Terrier Tzu) Norfolk Terrier, Norwich Terrier, Parson Russell Terrier, Patterdale Terrier, Pug Dog, Rat 8062 Malignant hyperthermia (MH) Terrier, Sealyham Terrier, Teddy Roosevelt Terrier, Tenterfield Terrier, , (all breeds) Toy Fox Terrier, , Welsh Terrier, Westphalia Terrier, Yorkshire Terrier) 8312 8452 May-Hegglin anomaly (MHA) Primary open angle glaucoma (POAG) (Pug Dog) (Basset Fauve de Bretagne, Basset Hound, Beagle, Norwegian Elkhound) 8032 8492 MDR1-gene defect* (Ivermectin hypersensibility) Protein losing nephropathy (PLN) (Australian Shepherd, Border Collie, Elo, German Shepherd, Longhaired Whippet, (Irish Soft-Coated Wheaten Terrier) McNab, Old English Sheepdog, Rough/Smooth Collie, Shetland Sheepdog, Silken 8104 Windhound, , Wäller) Pyruvate dehydrogenase phosphatase 1 deficiency (PDP1) 8306 Mucopolysaccharidosis type IIIa (MPS3a) (Clumber Spaniel, Sussex Spaniel) 8015 (Newzealand , Wirehaired Dachshound) Pyruvate kinase deficiency (PK) 8069 Mucopolysaccharidosis type VII (MPS7) (Basenji, Beagle, Cairn Terrier, Labrador Retriever, Pug Dog, West (Brazilian Terrier, German Shepherd) Highland White Terrier) 8068 8394 Muscular dystrophy (MD) Raine syndrome (Cavalier King Charles Spaniel, Golden Retriever, Landseer, Norfolk Terrier) (Border Collie) 8411 8301 Musladin-Lueke syndrome (MLS) Renal Cystadenocarcinoma and nodular fibrosis (Beagle) (RCND) 8220 Myostatin mutation (Bully-gene) (German Shepherd) 8150 (Whippet) Retinal dysplasia (OSD)* Optigen 8022 Myotonia congenita (Labrador Retriever, Samoyed) 8392 (Australian Cattle Dog, Miniature Schnauzer) Retinal dysplasia (OSD)* partnerlaboratory 8067 Narcolepsy (Labrador Retriever) 8328 (Dachshound, Dobermann, Labrador Retriever) Severe combined immuno deficiency (SCID) 8429 Necrotizing meningoenzephalitis (NME/PDE) (Frisian Water Dog, Jack Russell Terrier, Parson Russell Terrier) 8456 (Pug Dog) Skeletal dysplasia 2 (dwarfism) (SD2) 8172 Nemalin myopathy (NM) (Labrador Retriever) 8605 (American Bulldog) Spinal dysraphism (NTD) 8457 Neonatal cortical cerebellar abiotrophy (NCCD) (Weimaraner) 8537 (Beagle, Magyar ) Spinocerebellar ataxia (SCA) 8155 Neonatal enzephalopathy with seizures (NEWS) (Fox Terrier, Jack Russell Terrier, Parson Russell Terrier, Tenterfield Terrier) 8335 (Standard Poodle) Spondylocostal dysostosis (Comma defect) 8308 Neuroaxonal dystrophy (NAD) (Miniature Schnauzer) 8610 (Papillon, Spanish Waterdog) Spongy degeneration with cerebellar ataxia 8075 Neuronal ceroid lipofuszinosis (NCL) type 1 (SDCA1) (American Bulldog, Australian Cattle Dog, Australian Shepherd, Border Collie, () Chihuahua, Chinese Crested, Dachshound, English Setter, Golden Retriever, Tibetan 8582 Terrier) Spongy degeneration with cerebellar ataxia type 2 (SDCA2) 8396 Neuronal ceroid lipofuszinosis (NCL)* (Belgian Shepherd) 8191 (American Staffordshire Terrier) Startle disease 8602 Obesity (Irish Wolfhound) 8486 (Flat Coated Retriever, Labrador Retriever) Thrombopathia 8215 Osteogenesis imperfecta (brittle bone disease) (Basset Hound, Landseer) 8143 (Beagle, Golden Retriever, Shorthaired/Wirehaired Dachshound) Trapped neutrophil syndrome (TNS) 8630 Paroxysomal dyskinesia (PxD) (Border Collie) 8393 (Irish Soft-Coated Wheaten Terrier) van den Ende-Gupta syndrome 8462 Persistent Müllerian duct syndrome (PMDS) (Fox Terrier) 8302 (Miniature Schnauzer) Vitamin-D dependent rickets (VDR) 8017 Phosphofructokinase deficiency (PFKD) (Pomeranian) 8119 (American Cocker Spaniel, English Springer Spaniel, German Spaniel, Whippet) von-Willebrand disease type 1 (vWD I) 8142 Pituitary dwarfism (Bernese Mountain Dog, Coton de Tulear, Dobermann, Drentsche Patrijshond, (German Shepherd, Saalooswolfdog, Czechoslovakian Wolfdog) German Pinscher, Kerry Blue Terrier, Labradoodle, Manchester Terrier, Papillon, 8476 Pembroke Welsh Corgi, Poodle, Stabyhoun) Polycystic kidney disease (PKD) 8014 (Bull Terrier) von-Willebrand disease type 2 (vWD II) 8053 Postoperative hemorrhage (P2Y12) (German Shorthaired Pointer, German Wirehaired Pointer) 8233 (Great Swiss Mountain Dog) von-Willebrand disease type 3 (vWD III) 8141 Prekallikrein deficiency (KLK) (Kooikerhondje, Scottish Terrier, Shetland Sheepdog) 8347 (Shih Tzu) Warburg micro syndrome 1 (WARBM1) 8483 Primary ciliary dyskinesia (PCD) (Husky) 8063 (Old English Sheepdog) X-chromosomal severe immuno deficiency 8321 Primary Hyperoxaluria (PH) (Basset, Welsh Corgi) 8305 (Coton de Tulear) X-linked myopathy (XL-MTM) (Labrador Retriever, Rottweiler) ______

Requests, wishes, ... ______

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*Partnerlab In order to allow breeding club discount for the owner please enclose a breeding club membership confirmation with each sample submission. The invoice cannot be altered subsequently. Progressive retinal atrophy € €

8574 8094 Bas-PRA1 prcd-PRA* Optigen 8127 (Basenji) prcd-PRA* partnerlaboratory 8375 CNGA1-PRA (American Cocker Spaniel, American Eskimo Dog, Australian Cattle Dog, Australian (Shetland Sheepdog) Shepherd, Australian Stumpy Tail Cattle Dog, Bologneser, Bolonka Zwetna, 8135 Chesapeake Bay Retriever, Chihuahua, Chinese Crested, English Cocker Spaniel, crd-PRA (Wirehaired Dachshound) , Entlebucher Mountain Dog, Finnish Lapphund, German , Giant 8332 Schnauzer, Golden Retriever, Karelian Beardog, , Labradoodle, Labrador crd1-PRA Retriever, Lagotto Romagnolo, Lapponian Herder, Markiesje, (American Staffordshire Terrier) Norwegian Elkhound, Nova Scotia Duck Tolling Retriever, Portuguese Water Dog, 8333 crd2-PRA Poodle, Schipperke, Silky Terrier, , Swedish Lapphund, Wäller, (American Pitbull Terrier) Yorkshire Terrier) 8042 8042 Dominant PRA rcd1-PRA (Bull Mastiff, English Mastiff) (Irish Setter, Irish Red and White Setter) 8451 8042 Generalized PRA rcd1a-PRA () (Sloughi) 8200 8309 GR_PRA1 rcd2-PRA (Golden Retriever) (Collie) 8520 8042 GR_PRA2 rcd3-PRA (Golden Retriever) (, Chinese Crested Dog) 8573 8435 pap_PRA1 rcd4-PRA (Papillon, Phalène) (Australian Cattle Dog, English Setter, Gordon Setter, Irish Setter, Irish Red & 8444 Type A-PRA* Optigen White Setter, Polish Lowland Sheepdog, Small Munsterlander, Tibetan Terrier ) 8608 (Miniature Schnauzer) XL-PRA (Samoyed, Husky) ______

Coat colours / Coat length 8144 8146 A-locus (alleles: Ay, Aw, at, a) EM-locus (melanistic mask allele)

8023 8195 B-locus (brown, chocolate, liver(nose)) Furnishing (wire hair)

8124 8599 Coat length I (long or short hair) Hairlessness (powderpuff) Additional gene loci have to be analysed for complete characterisation in (Chinese Crested Dog, Mexican Hairless Dog, Peruvian Hairless Dog) 8254 the following breeds: H-locus (harlequin) Afghan Hound, Inu, Alaskan Malamute, , Eurasian, (Great Dane) 8405 Husky, Prague Rattler, Samoyed Improper coat 8397 Coat length II (long or short hair) (Portuguese Waterdog) 8145 K-locus (test for KB allele only) 8196 Curly (curled hair) (Please note: the alleles kbr (brindle) and ky cannot be determined using this test) 8136 8188 D-locus (dilution) M-locus* (, cryptic merle)

8018 8578 E-locus (apricot, cream, lemon, red, yellow) Panda white spotting (German Shepherd) 8458 8307 EG-locus (domino, grizzle) Saddle-tan (Afghan Hound, Saluki) (Basset Hound, Welsh Corgi) 8180 8438 EH-locus (sable) S-locus* (piebald, white spotting) (English Cocker Spaniel)

If more than one characteristic is requested we charge 35.71 € for the first and 15.01 € for each additional test (except S-locus).

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DNA-profiling ISAG 2006 8107 DNA profile (genetic fingerprint)

Please note: The person collecting the sample should be officially designated or appointed.

8109 Parentage analysis (paternity test) each parent each offspring

A DNA profile of each parent is necessary for parentage verification. If only one parent is available, this should be discussed prior to sample submission.

8211 8212 Breed determination (database analysis) Likelihood ratio calculation (analysis of blood relationship)

Please note: The test is only valid for certain breeds in our database. Additional information is available at www.laboklin.com or by calling us.

Supply orders for veterinarians: Submission forms:

1 6 14 100 160 Serum tubes Swabs with transp.medium Histology containers with Allergy Hygiene 2 6a 110 150 Cltrate tubes Swabs without transp.med. formalin General Farm Animal 3 6b 5 170 120 EDTA tubes Container for swabs Feacal containers Genetics Dog Pathology 3a 12 7 190 130 Heparin tubes Cover for slides Urine containers Genetics Cat Equine 4 11 1B 180 140 NaFI tubes Container for tubes Eppendorf tubes Genetics Equine Reptiles 10 80 22 210 Envelopes large Barcodes Packing boxes Birds and Small Mammals General terms and conditions: Prices in Euro excl. VAT (19%) / Charge is x1.4 if invoice is sent to owner with an additional fee of 2.80 € for postage and packing / Services offered and prices may be subject to change / Samples and anonymised test results can be used for scientific purpose / Please find our complete general terms and conditions of business on www.laboklin.com GB - 011005017 / 1707