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Spirochete Request Form

Requestor Information:

Address:

Institution Type:

U.S. Public Health Institution
Academic
Government

Specimen Request Information

By checking this box, the requestor agrees to follow all necessary safety precautions involved with the handling of live spirochete organisms including but not limited to the use of adequate personal protection equipment.
By checking this box, the requestor acknowledges the specimens will be used only for the intended purpose of laboratory training for dark field microscopy. Vials are provided as 0.5 milliliter aliquots with 5 organisms per coverslip.
By checking this box, the requestor acknowledges specimen shipments will only be sent to domestic and not international addresses.
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