Veterinary Investigation Centre
Staplake Mount
Starcross
Devon
EX6 8PE / T +44 (0)1626 891121
F +44 (0)1626 891766
Twitter:@APHA / For AHPA use only
AHPA Ref No:
Date received:
Bovine Genital Campylobacter and Trichomonas Tests
Client’s name and address / Veterinary Practice/AI Unit
Postcode:
CPH No:
Previous ref (if applicable):
Date sample taken / Time sample taken / Case Veterinary Surgeon:
Ihavetakenthesesamples, as detailed in the sampling instructions, from the animals described below / Signature: / MRCVS / Date:
N.B. Resultswillnotbeissuedforstatutorytestsunlessthisformhasbeensignedbythesubmittingveterinarysurgeon
Reason for Submission (tick as appropriate): / Tests required(tick as appropriate):AI - Pre-quarantine (includes EU 1St Series/Domestic Centre/Unlicensed Premises) / Sheath wash/vaginal lavage in PBS
AI - In quarantine (EU 2nd Series testing) / Campylobacter FAT
AI - Annual test/AI other / Trichomonas Culture
Export/Other / Sheath wash/vaginal lavage in TEM broth
Diagnostic / Campylobacter Culture
Samples MUST be received at the laboratory within 24hours of being taken
Sample identificationPlease continue on a separate sheet if necessary / Before taking samples, please inform APHA Starcross by telephone (01626 891121) or email
Please send samples by courier to ensure arrival within 24hrs of sampling, and before 16:00 hours. Address samples to:
APHA Starcross, Staplake Mount, Starcross, EX6 8PE
Please do not send samples to arrive on a weekend, and please do not send close to Bank Holidays without consulting the laboratory first.
Please do not send samples with ice packs as it may affect Trichomonas viability.
Sample/Animal I.D. / Ear Tag/Other I.D.
For APHA use only
Received: / PBS x / Paired Tem broth x
Signed: / Date:
Please tick if samples cannot be used for anonymous surveillance or test validation purposes
DATA PROTECTION
For information on how we handle personal data please go to and search Animal and Plant Health Agency Personal Information Charter.
CAMPY-TRICH 1 (Rev. 05/18)