Contact
New Bolton Center Kennett Square, PA
Emergencies & Appointments:
610-444-5800
Directions
Ryan Hospital Philadelphia, PA
Emergencies:
215-746-8911
Appointments:
215-746-8387
Directions

Request for Split Sample Analysis

Please use this form to request split sample analysis by PETRL. PETRL will consider your request and respond directly to the submitter.

Note: This form has been developed in accordance with the standards of the Racing Medication & Testing Consortium. 

(First Name and Last Name)
(sample: janedoe@doe.com)
Analysis Requested:

(if applicable)
Matrix to be Analyzed: (indicate all to be submitted for analysis)



Hydrolysis Used in Primary Analysis:

Sample Condition:


Sample Age: (interval post-collection)


Party Responsible for Payment: