Tissue Request Form

Pricing for External Academic and Commercial Clients

For external pricing information, please complete the form as thoroughly as possible and we will reply with a quote for our services.

Pricing for UMass Clients

For internal UMass-only pricing, please Contact Us.

Quoted fees are best estimates for requested service. Actual cost will be determined at completion of service.


 PLEASE NOTE: You may need to amend your IBC protocol if you are a first time user of fresh tissue. Please see our FAQ page for more information.

Requestor Information  
*Name:  
*Phone:  
*Email:  
Principal Investigator Information (if different than Requestor)  
Name:  
Email:  
PI Membership Status
   
Responsible Party Billing Information  
Responsible Party:
UMass Speedtype or External PO#:
   
Brief Project Description:
Protocol Title and Number:
IRB Approval #:
IRB Approval Date:


Sample Requests  
Select type of biospecimen requested:
Matched Normal Needed?
Select the biospecimen cancer type:
   
Is data needed?
   
Please list any additional specific characteristics of requested tissue here:
   
   
 

Specimen User Agreement

Investigators receiving specimens from the UMass Medical School Tissue and Tumor Bank (UMass Tissue Bank) hereby agree to acknowledge the contributions of the UMass Tissue Bank in all publications resulting from the use of these specimens.  Investigators agree to assume all risks and responsibility in connection with the receipt, handling, storage and use of specimens.  Investigators further agree to indemnify and hold harmless the UMass Tissue Bank for costs, damages or expenses resulting from the use of the tissues provided. 

Tissues are provided as a service to the research community without warranty of merchantability or fitness for a particular purpose or any other warranty, express or implied. The UMass Tissue Bank operates on a fee for service model and all fees reflect the actual expenses of cost recovery in providing services.

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