ZooOmics



Client’s details:Client’s name: Address:Postal code: Tel/Cell: E-mail: ACCOUNT FOR: Name: VAT No.:Address:Postal code: Tel/Cell: E-mail: Payment and results:Preferred method of receiving results:E-mailPost?E-mail to be sent to:Method of payment: CashElectronic transferAnimal’s details:Canine’s Name:Microchip No.:Registration No.:Breed:Colour:Sex:MFDate of birth:YYYY/MM/DDHealth Certificate Databases:KUSA requires all test results of dogs registered to be included into their Health Certificate Database - inqaba biotec? requires your consent before issuing the data.On behalf of the LABRADOR RETRIEVER KENNEL CLUB and their Health Survey, we would like your permission to share your test statistics. NO personal details of the client/patient will be shared, ONLY the test statistic(s).I hereby give my permission that inqaba biotec? may send all tests results to KUSA to form part of the KUSA Health Certificate Database ??Yes ??NoI hereby give my permission that inqaba biotec? may send tests statistics to the LABRADOR RETRIEVER KENNEL CLUB ??Yes ??No-8626168431Degenerative Myelopathy (SOD1)Juvenile Laryngeal Paralysis & Polyneuropathy (JLPP) (Various Breeds)(Rottweiler)Cystinuria Leukoencephalomyelopathy LEMP (NAPEPLD)(Various Breeds)(Rottweiler)Pyruvate Kinase Deficiency (PKLR)X-linked myotubular myopathy (MTM1)(Labrador Retriever, Pug, Beagle)(Rottweiler) Centronuclear Myopathy (BIN1)Neuroaxonal Dystrophy (VPS11)(Great Dane)(Rottweiler) Centronuclear Myopathy (PTPLA)Neuroaxonal Dystrophy (NAD) PLA2G6(Labrador Retrievers & Labradoodles)(Papillon) Copper Storage Disease (ATP7B)SeSAME-EAST Ataxia (KCNJ10)(Labrador Retrievers & Labradoodles)(Belgian Shepherds)Exercise Induced Collapse (NEI) Neuronal Ceroid Lipofuscinosis (1TRP1)(Various Breeds)(Italian Spinone)Progressive Retinal Atrophy (PRCD)Novell Cerebellar Cortical Degeneration (SNX14)(Various Breeds)(Hungarian Vizsla & Weimaraner)Progressive Retinal Atrophy (GR_PR1)Neural Hypomyelination (FNIP2)(Golden Retriever)(Weimaraner)Progressive Retinal Atrophy (GR_PR2)Spinal Dysraphism (NKX2-8)(Golden Retriever)(Weimaraner)Progressive Retinal Atrophy (crd1) Congenital Myotonia (CIC1)(Dachshunds, Bulldogs, Spaniels)(Miniature Schnauzer, Jack Russel Terrier)Progressive Retinal Atrophy (rcd1) Late onset Spinocerebellar Ataxia (CAPN1)(Irish Setters and Irish Red-and-White Setters)(Jack Russel, Schnauzer, Australian Cattle Dog)Progressive Retinal Atrophy (rcd3)Spinocerebellar Ataxia (KCNJ10)(Corgi breeds and Chinese Crested)(Jack Russel Terrier and Parson Russel)Progressive Retinal Atrophy (cnga1)L2-Hydroxyglutaric Aciduria (L2HGA) (Shetland Sheepdog)(Staffordshire Bull Terrier)Progressive retinal atrophy XL-PRA (RPGR)Familiar Nephropathy (FN) (Husky, Samoyed)(Cocker Spaniel)Goniodysgenesis & Glaucoma (OLFML3)Myoclonic Epilepsy (DIRAS1)(Border Collie)(Rhodesian Ridgeback)Primary Open Angle Glaucoma (ADAMTS10)Arrhythmogenic Right Ventricular Cardiomyopathy (STRN)(Beagle)(Boxer)Primary Lens Luxation (ADAMTS17) Dilated Cardiomyopathy (PDK4 & RBM20)(Various Breeds)(Dobermann)Heritable cataracts (HSF4)Hereditary Nasal Parakeratosis (SUV39H2)(Staffordshire Bull Terrier, Boston Terrier, French Bulldog, Australian Shepherd)(Labrador Retrievers)Canine Multifocal Retinopathy 1 (BEST1)Ichthyosis (PTPLA1)(Mastiffs, Bullmastiffs, English/French/American Bulldog, Australian shepherds)(Golden Retriever)Achromatopsia (CNGB3)Musladin Leuke Syndrome (ADAMTSL2)(Husky, Malamute)(Beagle)Photoreceptor dysplasia (PDC)Lupus Erythematosus (DPF2)(Belgian Shepherd & Schnauzer)(German pointer)Collie Eye Anomaly (CEA)Lethal Acrodermatitis (LAD) MKLN1(Australian Shepherd, Border Collie, Rough and Smooth Collie, Shetland Sheepdog)(Bull Terrier Breeds)Multiple drug resistance (MDR1)Polycystic Kidney Disease (BTPKD)(Various Breeds)(Bull Terrier Breeds)Imerslund-Gr?sbeck Syndrome (IGS)Phosphofructokinase (PFK) (Border Collie & Beagle)(English Springer Spaniels)Trapped Neutrophil Syndrome (TNS)Factor VII deficiency (FVII)(Border Collie)(Beagle)Neuronal Ceroid Lipofuscinosis (CLN5)von Willebrand’s Disease Type I(Border collie, Australian Cattle Dog, Golden Retriever)(Various Breeds)Neuronal Ceroid Lipofuscinosis (CLN1/PPT1)von Willebrand’s Disease Type III (Dachshund)(Shetland Sheepdogs and Scottish Terriers)Neuronal Ceroid Lipofuscinosis (CLN2/TTP1)Haemophilia B (Factor IX)(Dachshund)(Rhodesian Ridgeback)Neuronal Ceroid Lipofuscinosis (CLN6)Cleft Palate (DXL6)(Collie & Shepherd breeds)(Nova Scotia Duck Tolling Retriever)Neuronal Ceroid Lipofuscinosis (CLN8)Cleft Palate (ADAMTS20)(Collie & Shepherd breeds)(Nova Scotia Duck Tolling Retriever)Neuronal Ceroid Lipofuscinosis (CTSD)Juvenile-Onset Inherited Polyneuropathy (ARHGEF10)(Bulldogs)(Leonberger & Saint Bernard) - in developmentNeuronal Ceroid Lipofuscinosis (CLN8)Ridgeback Dermoid Sinus(English Setters)(Rhodesian Ridgeback) - requesting affected samplesCerebellar Ataxia (ARSG)Raine Syndrome (FAM20C)(Bull Terrier breeds)(Border Collie) - in developmentNeonatal cerebellar cortical degeneration NCCD (SPTBN2)Sensory Neuropathy (FAM134B)(Beagle)(Border Collie) - in developmentOther: __________________________________00Degenerative Myelopathy (SOD1)Juvenile Laryngeal Paralysis & Polyneuropathy (JLPP) (Various Breeds)(Rottweiler)Cystinuria Leukoencephalomyelopathy LEMP (NAPEPLD)(Various Breeds)(Rottweiler)Pyruvate Kinase Deficiency (PKLR)X-linked myotubular myopathy (MTM1)(Labrador Retriever, Pug, Beagle)(Rottweiler) Centronuclear Myopathy (BIN1)Neuroaxonal Dystrophy (VPS11)(Great Dane)(Rottweiler) Centronuclear Myopathy (PTPLA)Neuroaxonal Dystrophy (NAD) PLA2G6(Labrador Retrievers & Labradoodles)(Papillon) Copper Storage Disease (ATP7B)SeSAME-EAST Ataxia (KCNJ10)(Labrador Retrievers & Labradoodles)(Belgian Shepherds)Exercise Induced Collapse (NEI) Neuronal Ceroid Lipofuscinosis (1TRP1)(Various Breeds)(Italian Spinone)Progressive Retinal Atrophy (PRCD)Novell Cerebellar Cortical Degeneration (SNX14)(Various Breeds)(Hungarian Vizsla & Weimaraner)Progressive Retinal Atrophy (GR_PR1)Neural Hypomyelination (FNIP2)(Golden Retriever)(Weimaraner)Progressive Retinal Atrophy (GR_PR2)Spinal Dysraphism (NKX2-8)(Golden Retriever)(Weimaraner)Progressive Retinal Atrophy (crd1) Congenital Myotonia (CIC1)(Dachshunds, Bulldogs, Spaniels)(Miniature Schnauzer, Jack Russel Terrier)Progressive Retinal Atrophy (rcd1) Late onset Spinocerebellar Ataxia (CAPN1)(Irish Setters and Irish Red-and-White Setters)(Jack Russel, Schnauzer, Australian Cattle Dog)Progressive Retinal Atrophy (rcd3)Spinocerebellar Ataxia (KCNJ10)(Corgi breeds and Chinese Crested)(Jack Russel Terrier and Parson Russel)Progressive Retinal Atrophy (cnga1)L2-Hydroxyglutaric Aciduria (L2HGA) (Shetland Sheepdog)(Staffordshire Bull Terrier)Progressive retinal atrophy XL-PRA (RPGR)Familiar Nephropathy (FN) (Husky, Samoyed)(Cocker Spaniel)Goniodysgenesis & Glaucoma (OLFML3)Myoclonic Epilepsy (DIRAS1)(Border Collie)(Rhodesian Ridgeback)Primary Open Angle Glaucoma (ADAMTS10)Arrhythmogenic Right Ventricular Cardiomyopathy (STRN)(Beagle)(Boxer)Primary Lens Luxation (ADAMTS17) Dilated Cardiomyopathy (PDK4 & RBM20)(Various Breeds)(Dobermann)Heritable cataracts (HSF4)Hereditary Nasal Parakeratosis (SUV39H2)(Staffordshire Bull Terrier, Boston Terrier, French Bulldog, Australian Shepherd)(Labrador Retrievers)Canine Multifocal Retinopathy 1 (BEST1)Ichthyosis (PTPLA1)(Mastiffs, Bullmastiffs, English/French/American Bulldog, Australian shepherds)(Golden Retriever)Achromatopsia (CNGB3)Musladin Leuke Syndrome (ADAMTSL2)(Husky, Malamute)(Beagle)Photoreceptor dysplasia (PDC)Lupus Erythematosus (DPF2)(Belgian Shepherd & Schnauzer)(German pointer)Collie Eye Anomaly (CEA)Lethal Acrodermatitis (LAD) MKLN1(Australian Shepherd, Border Collie, Rough and Smooth Collie, Shetland Sheepdog)(Bull Terrier Breeds)Multiple drug resistance (MDR1)Polycystic Kidney Disease (BTPKD)(Various Breeds)(Bull Terrier Breeds)Imerslund-Gr?sbeck Syndrome (IGS)Phosphofructokinase (PFK) (Border Collie & Beagle)(English Springer Spaniels)Trapped Neutrophil Syndrome (TNS)Factor VII deficiency (FVII)(Border Collie)(Beagle)Neuronal Ceroid Lipofuscinosis (CLN5)von Willebrand’s Disease Type I(Border collie, Australian Cattle Dog, Golden Retriever)(Various Breeds)Neuronal Ceroid Lipofuscinosis (CLN1/PPT1)von Willebrand’s Disease Type III (Dachshund)(Shetland Sheepdogs and Scottish Terriers)Neuronal Ceroid Lipofuscinosis (CLN2/TTP1)Haemophilia B (Factor IX)(Dachshund)(Rhodesian Ridgeback)Neuronal Ceroid Lipofuscinosis (CLN6)Cleft Palate (DXL6)(Collie & Shepherd breeds)(Nova Scotia Duck Tolling Retriever)Neuronal Ceroid Lipofuscinosis (CLN8)Cleft Palate (ADAMTS20)(Collie & Shepherd breeds)(Nova Scotia Duck Tolling Retriever)Neuronal Ceroid Lipofuscinosis (CTSD)Juvenile-Onset Inherited Polyneuropathy (ARHGEF10)(Bulldogs)(Leonberger & Saint Bernard) - in developmentNeuronal Ceroid Lipofuscinosis (CLN8)Ridgeback Dermoid Sinus(English Setters)(Rhodesian Ridgeback) - requesting affected samplesCerebellar Ataxia (ARSG)Raine Syndrome (FAM20C)(Bull Terrier breeds)(Border Collie) - in developmentNeonatal cerebellar cortical degeneration NCCD (SPTBN2)Sensory Neuropathy (FAM134B)(Beagle)(Border Collie) - in developmentOther: __________________________________gENETIC health Test required-15527525016600Colour Test required:Colour inheritance (please select)A Locus (ASIP: c.244 G>T; c.248G>A; c.286C>T; SINE)?E Locus (MC1R: c.799A>G; c.914C>T)?B Locus (TYRP1: c.121T>A; c.991C>T; c.1033delCCT; c.555T>G)?K Locus (CBD103: delGGA)?D Locus (MLPH: c.-22G>A; c.705G>C)?S Locus (MITF: c.478 C>T)Hair length (FGF5: c.284G>T)M locus (Merle – in development)OTHER: _____________________________DNA PROFILE REQUIRED:As of 1 April 2018, KUSA instituted the requirement of a DNA profile for import/export permit registrations and transfer of registered ownership of dogs.Parentage testing:(if PARENTAGE IS REQUIRED PLEASE complete RELATIONSHIP details)Canine’s NameMicrochip No.Registration No.Gender(Male/Female)Relationship (i.e. Puppy, Bitch, Sire)Sample declaration:I confirm that the sample enclosed was obtained from the dog described above.Name and signature of person taking the sample: ________________________________________________Name and signature of client: ________________________________________________________________Sample label: __________________________ Date samples were collected: YYYY/MM/DDSample type: 1 – 2 ml Whole Blood in EDTA tube ?FTA card ??Please note that only blood samples received in EDTA tubes will be stored. No FTA cards are stored.ZooOmics? is the Animal Genetics division of inqaba biotec? that will be launched officially 2019/07/01. We have many exciting new developments in the pipeline: Keep an eye on your mailbox! ZooOmics? is a collaboration between Clinomics and inqaba biotec?, making use of additional extensive panels currently used by Clinomics in combination with the service delivery capacity for which inqaba biotec? is well-known; to provide the most comprehensive value for money panels for parentage and bovine mutation analysis. The genetic health and colour tests will still be provided by inqaba biotec? through our ZooOmics? division. ................
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