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Your sample ID  Received in Approx Fix time Request date Cost centre / grant codeFrozen or Paraffin sections?HISTOLOGY request formYour Group LeaderYour Name HereF or P`Haematoxylin & eosin, IHC & ISH requsts here. Number of slides to be stained from each cut block^1, 2, 3 or 4 sections per slide please note size of sample before requesting multiple sections Leave BlankDetails of specific embedding required here. Details of any unusual fixation. Details of date sample required by (please note 2 week standard turnaround time). Details of any labelling of slides required3The number that matches the block or sample povidedType of tissue e.g. spleenHuman, mouse etcType of fixative if usedHDuration of fixation (optimal formalin or paraformaldehyde 12- 24 hours)Date submittedNIf fixative removed and samples placed in alcohol or PBS etc please state here7Additional information about the specific sample here. ITotal number of samples submitted. 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