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.

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:
   
   
 
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