I am a UNSW Researcher / Student (please complete below)
UNSW
zID:
Faculty/School:
Payment
is by UNSW account. Please complete fund, dept id and project no. details below
Fund:
Dept ID:
Project No:
Account Owner Name:
(if different from Supervisor Name above)
I am an External User (please complete below)
Organisation:
Department/Unit:
Address (optional):
Payment is by tax invoice (we will issue a tax invoice for payment)
KGLMF BIOSPECIMEN
PREPARATION LABORATORY
SERVICE REQUEST FORM
USER DETAILS
(ALL USER AND ACCOUNT FIELDS ARE MANDATORY)
Incomplete forms will delay processing
Name:
Mobile/Phone:
Email:
Supervisor:
BSP USE ONLY
Date
Accepted
Accepting
Officer
Total No.#
Samples
Total No.#
Slides
Date
Completed
JOB NUMBER: BSP-
SAMPLE DETAILS
The KGLMF biospecimen preparation laboratory is a PC1 facility; only non-radioactive risk group 1
organisms will be accepted for processing. Viral transfected cell lines or tissues derived from GMOs
MUST no longer be viable.
Fixed cells - Cell line/ATCC No
- GMO/NLDR/Exempt dealings protocol
Fixed Tissue – Animal/organ Human/organ
- Animal/Human ethics protocol
JOB DETAILS
Sample Embedding (Paraffin only)
No# Samples:
Embedding Orientation:
(ALWAYS discuss with BSP staff before job submission and attach any additional information)
Attach a list of samples – page 3
Slide Sectioning
Paraffin
Frozen (
Fix Frozen sections? Fixative: )
Total No# of blocks:
No# of Slides per Block: No# Sections per slide:
Section Thickness:
Attach a list of samples – page 3
H&E Histology staining
Total No# of slides:
Special Stains
Total No# of slides: Protocol Required:
Control Tissues:
Immunostaining
Single labelling
Multiple Labeling
Total No# of slides:
Antibodies:
Positive Controls: Secondary Staining:
Attach a list of all antibodies – page 3
I ........................................................................ (
user
), have read and understood the above listed
sample limitations (PC1 samples only), and agree to the prices listed on the reverse of this form for
processing my samples.
Signature: Date:
List of samples (embedding or sectioning)
– add additional lines if required
This information will be used for embedding cassette and slide labels
Description
Organ
additional notes
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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23
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25
26
27
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Immunostaining antibody information
primary antibody
catalogue #
dilution
secondary antibody
catalogue #
dilution
Charges for Histology and Microscopy Preparation (BSP)
BSP Grouping
Protocol
Price (
Ex GST)
(UNSW User/Partner)
Price (
Ex GST)
(External User)
Job
Embedding
Paraffin Embedding
$5.00
$9.00
Per Block
Paraffin Slide Sealing
$1.00
$2.00
Per Slide
Sectioning
Paraffin Sectioning
$5.00
$2.00
$9.00
$4.00
For first slide from each block
For subsequent slides from same block
Cryosectioning
$5.00
$2.00
$9.00
$4.00
For first slide from each block
For subsequent slides from same block
Microtome DIY
^
$20.00
$36.00
Per Hour (1 hour training required for new users)
Vibratome DIY
^
$20.00
$36.00
Per Hour (1 hour training required for new users)
Cryomicrotome DIY
^
$25.00
$45.00
Per Hour (1 hour training required for new users)
Microtomy Subscription DIY
^
(Yearly)
$400.00
N/A
For usage ≥ 20 hours within the calendar year
(1st Jan – 31st Dec)
Staining
H&E Staining
$5.00
$2.00
$9.00
$4.00
For first slide of each stain
For subsequent slides from same stain
Immunostaining - chromogenic DAB
$20.00
$36.00
Per one antibody on slide (does not include
sectioning; primary antibodies to be
provided by user)
Immunostaining - Fluorescence
$20.00
$36.00
Per one antibody on slide (does not include
sectioning; primary and secondary antibodies
to be provided by user) - additional primary
antibody $20/$35 each
Special Stains
TBD
TBD
Pricing depends on protocol
^
DIY – Do It Yourself (self service)