ANIMAL HEALTH LABORATORY
AHL Small poultry flock project (Oct 1/15 to Sept 29/17)
PM
Lab use only
Any questions? Please contact the lab.
Email: ahlinfo@uoguelph.ca
Website: http://ahl.uoguelph.ca
AHL GUELPH: 519-824-4120 ext: 54530, Fax: 519-827-0961
AHL KEMPTVILLE: 613-258-8320, Fax: 613-258-8324
Important. Please read. Contact Information must be supplied with all samples submitted for testing to the Animal Health Lab (“AHL”). Agricultural animal testing carried out through AHL is
subsidized by the Government of Ontario. By submitting samples for testing to AHL, the submitter acknowledges that s/he is the owner or is a duly authorized agent of the owner. The
submitter acknowledges and agrees that AHL may share test results and contact information as it deems necessary for the purposes of relevant legislation regarding reportable or notifiable
diseases and for the purpose of surveillance of animal or public health in Ontario.
Clinic No. AHL USE TEMPLATE: SMALLFLOCKPM-001
Owner
Clinic Complete Home Address including 911 number
Address Postal Code
Cit
y Phone Complete Barn Address if different from Home including 911 number
Veterinarian Fax Barn/Pen/Floor/Batch ID
Email Phone Fax
Project : AHL Small poultry flock project Email
***DEMOGRAPHIC INFORMATION IMPORTANT***
Species Avian
Br
eed
Sex: F M mixed
Age
d w m y
Type of Bird (check)
Chicken (small flock) Turkey ( small flock)
Waterfowl: Duck Goose
Gamebird: quail partridge pheasant
grouse grouse peacock
Animals submitted #live #dead Other specimens
Date/time of death Died or Euthanized/method
CLINICAL HISTORY List clinical problems (e.g. nervous, diarrhea, pneumonia, etc.)
1 3
2 4
Relevant History (include additional information regarding flock, composition, source of
birds, date(s) of onset of problems)
Cli
nical pathology
Sum
mary of recent therapy
Vac
cinations (in hatchery, on farm)
Mana
gement (housing, nutrition, etc.)
AHL Small Poultry Flock Project PM-2015
Page 1 of 2
Private Cremation?
YES
NO
POSSIBLE
SPECIFIC INSTRUCTIONS
AHL - Guelph Courier Address
UoG Animal Health Lab-PAHL
419 Gordon Street-Bldg 89
Guelph, ON N1G 2W1
Attn: Specimen Reception
Animal Health Laboratory
Laboratory Services Division
Univ of Guelph/Kemptville
Campus
79 Shearer Street
Kemptville, Ontario K0G 1J0
SAMPLES TAKEN Date: _________/_____/_____(yyyy/mm/dd) Time of day _____:_____ Date sent________/____/____ yyyy/mm/dd)
SUBMITTED BY Veterinarian Owner Agent BILL Veterinarian Agent Owner
Requirements to be part of the Project
Name of Vet (Reports only go to Vet)
Fully Completed AHL Submission form
Fully Completed Husb. & Bios. Questionnaire
Owner Signed Consent Form
Payment of $25.00
Suitable Samples
Insurance and potenal ligaon cases are not included in this project. Charges associated with private
cremaon including lab associated fees are in addion to the $25.00 fee.
Flock Size
No
. at risk _____________
No
. sick _______________
No
. dead ______________
Weig
ht________ kg
Duration of problem
d wks m y
Purpose, (check) : Meat meat breeder layer
dual purdual purpose breeder exhibition club
layer breeder other
hobby
companion
