REQUEST FORM FOR HISTOLOGY

Name　　　　　　　　　　　　　　Date

Species 　 Mouse,　 Rat, Rabbit, Human

Type of tissue Femoral Artery, Transplanted Heart, Muscle, Carotid artery, others

Study Name

参照実験ノート 　　　　　　　　　　　　　　　　　　　　　　　　　　

Sample No.

Fixatives: Formalin, Paraformaldehyde, Methanol, Ethanol,

others ( )

Prescription:

1. Paraffin ( ) or Frozen section ( )

2. Longitudinal ( ) or Cross Section ( )

3. Slide: HE (x ), ET (x ), No heat (x ), Others(x )

4. Continuous cuts ( ) or

Uncontinuous with an interval of ( ) cuts between slides.

5. Special request:

Priority rating: top ( ), no rush( )