Search

CIVC Form

Cardiovascular Ischemia and Vasculogenesis Core (CIVC)

Service Request Form

 

 

Contact: __________________________                 Date of request:___________________

 

PI :______________________________                  

 

Department: _______________________

 

Telephone: ________________________                 Email: __________________________

 

Account # _________________________                 FAX: ___________________________

 

IACUC Protocol #:  _______________

 

 

Please indicate the service(s) that you are requesting:

 

__ Heart failure model                         __ Myocardial infarction model                      

__ Hindlimb ischemia model                          __ Laser Doppler imaging                 

__ Ultrasound                                                  __ Histology/staining

__ Invasive hemodynamics                            __ Cannulation

__ Dosing studies                                           __ Necropsy   

__ Intubation                                                    __ Procedure training

__ Whole animal perfusion                             __ Protocol Development

 

 

 

Provide a brief overview of the project.


 

 

Please provide the following information (if known):

 

Species _____________                                Strain ______________

 

Animal # ____________                                 Male/Female ___________

 

Age/Weight __________       

 

 

Return this form to Dr. Brian Johnstone (bhjohnst@iupui.edu) or Todd Cook (tgcook@iupui.edu).

For a link to the Microsoft Word Document, click here.

 

Indiana Center for Vascular Biology & Medicine
975 West Walnut Street, IB 445
Indianapolis, IN 46202   

278-6107 or 274-1580    

1481 W. 10th St., C3105 | Indianapolis, IN 46202 | Ph: (317) 988-4976 | Fax: (317) 988-9325