Equine DNA Test Submission Form Please complete the form to the best of your knowledge. Some test are preformed by partner labs or labs located outside the UK. Results of these tests may take a little extra time. 1. 2. 3. 4. Send 30-40 mane or tail hairs pulled with roots attached in a plastic zip-lock bag. Label bag with the horse’s name as indicated on this form. Include cheque, money order or credit card information for the appropriate amount. Post samples to the address indicated below. Results are sent to Svenska Tinkerhästsällskapet (Swedish Tinker Horse Association) Account # Date: Owner Info Address:__________________________________________________ City:______________________________________ Registry Info (If known) Name:_______________________________________ Business Name:__________________________________________ Horse Name:_________________________________________Registration #:_______________________________ County/State:__________________________ Post Code:____________________ Country:__________________________ E-Mail Address:____________________________________________Phone/Fax:_________________________________ Year of Birth:_______ Sex:_______ Breed:____________________________Colour:__________________________ Sire's Name:______________________________________Reg #:_________________________________________ Breed:____________________________________ Colour:_______________________________________________ Dam's Name:______________________________________Reg #:_________________________________________ Breed:____________________________________ Colour:_______________________________________________ EQUINE COAT COLOUR Red Factor Agouti (Bay/Black) Splashed White (SW-1, SW-2, SW-3) Required Tests Lethal White/Frame Overo Appaloosa (LP) or (CSNB) Tobiano Sabino1 Dominant White (W5, W10) Cream Dilution EQUINE GENETIC DISORDERS Congenital Stationary Night Blindness (CSNB) or (LP) Hereditary Equine Regional Dermal Asthenia (HERDA) Hyperkalemic Periodic Paralysis (HYPP) Glycogen Branching Enzyme Deficiency (GBED) Junctional Epidermolysis Bullosa (JEB1, JEB2) Polysaccharide Storage Myopathy (PSSM) Malignant Hyperthermia (MH) Cerebellar Abiotrophy (CA) Lavender Foal Syndrome (LFS) Severe Combined Immunodeficiency Disease (SCID) Champagne Dilution Pearl Dilution EQUINE TYPING PROFILE Silver Dilution Individual DNA Profile (ISAG profile) DUN Foal _____________________________ Mare _____________________________ Grey Parentage Verification Sire 1_____________________________ Sire 2_____________________________ Om du önskar göra fler tester än mot PSSM1, kontakta vår kontaktperson (se hemsida). Observera att provsvaren kommer att skickas till STS som meddelar dig som hästägare resultatet. Om du inte vill testa för PSSM1, vänligen kontakta labbet på egen hand. Om du använder detta formulär tillsammans med remiss för DNA-provtagning behöver du ej ange betalinformation, du betalar enligt information på vår hemsida (pris kan variera pga växlingskurs). Postens avgifter tillkommer om annat ej avtalats. UK is not responsible for the origin/source of samples submitted by the individual customer. By submitting this form, the customer understands that Animal Genetics shall in no way be liable for any incidental or consequential damages of any kind. Animal Genetics