Clinical signs at Revisit Animal name Neurological signs* Rectal Lameness Colic Weight loss Samples collected (Y please describe) – temperature (Y/N) (Y/N) (Y/N) (tick) (Y/N) Blood: EDTA □ Whole □ Blood: EDTA Whole □ □ Blood: EDTA Whole □ □ Blood: EDTA Whole □ □ Blood: EDTA Whole □ □ Blood: EDTA Whole □ □ * Neurological signs may include ataxia, depression, altered mental state, muscle fasciculations, hypermetria, hyperaesthesia, circling, recumbency, facial paralysis, blindness, seizures Please forward samples to Veterinary Diagnostic Services, AgriBio Specimen Reception, 5 Ring Road, La Trobe University Bundoora, Victoria, 3083 Phone: (03) 9032 7515 – Fax: (03) 9032 7604 Email: For more information please contact the duty pathologist on (03) 9032 7515
Clinical signs at Revisit Animal name Rectal temperature Neurological signs* (Y – please describe) Lameness (Y/N) (Y/N) Colic (Y/N) Weight loss (Y/N) Samples collected (tick) Blood: EDTA □ Whole □ Blood: EDTA □ Whole □ Blood: EDTA □ Whole □ Blood: EDTA □ Whole □ Blood: EDTA □ Whole □ Blood: EDTA □ Whole □ * Neurological signs may include ataxia, depression, altered mental state, muscle fasciculations, hypermetria, hyperaesthesia, circling, recumbency, facial paralysis, blindness, seizures Please forward samples to – Veterinary Diagnostic Services, AgriBio Specimen Reception, 5 Ring Road, La Trobe University Bundoora, Victoria, 3083 Phone: (03) 9032 7515 Fax: (03) 9032 7604 Email: For more information please contact the duty pathologist on (03) 9032 7515
Equine-Arbovirus_Submission-Form_REVISIT.docx