Bali Mynah Diagnostic Submission Form for Atoxoplasma

Note: Please submit 1 form for each individual sample collected.

Dr. Ellis Greiner
University of Florida
Department of Pathobiology
College of Veterinary Medicine
PO Box 100145
Gainesville, FL 32610-0145



Institution ID #:________________

Studbook #:_______

Sample collected and date:





Pre-treatment sample collection Yes or No (circle)

Post-treatment sample collection Yes or No (circle)

Treatment regimen used: drug, dose, route of administration, time period on drug, adverse side effects