Phone: 714-891-2022 | Fax: 714-891-2123 | info@hemopet.org | 11561 Salinaz Avenue, Garden Grove, CA 92843

The Hemopet/Hemolife Test Request Form and Instructions can now be filled out online using the blank form shown below. You can send the samples by courier (FedEx) or alternative delivery through the Postal Service or other courier such as UPS. For International Samples, including Canada and Mexico, see special shipping instructions. US Customs clearance requires a letter specifying that the "sample is from a dog or cat for diagnostic purposes only, and is non-infectious."
Veterinarian First Name
Last Name
Clinic Name
Address: Email Confirm Email
send report to this Email-address
City State Zip
Phone Fax Cell

Client First Name
Last Name
Address Email Confirm Email
send report to this Email-address
City State Zip
Phone Fax Mobile

Pet Name Species Breed
Pet Age Yrs Months Sex WeightLbs
Pet Diet

Reason for testing & brief history
Thyroid Medication check here if on Thyroid Medication.
List all Medication How much? How often?
Blood drawnhrs since last pill

Click the submit button below to submit & print your request and generate your tracking number.

Check tests desired and enclose appropriate fees (Prices in US dollars)
Cost
Thyroid Profile 5™ PLUS WHOLE BLOOD & SERUM NEEDED (T4, free T4, T3, free T3, TgAA - PLUS CBC, Differential, Chemistries)
$ 160.00
Thyroid Profile 5™ (T4, free T4, T3, free T3, TgAA)
$ 95.00
Thyroid GOLD™ Registration & Certificate ONLY (Order with ANY Thyroid Profile 5)
Will ONLY be issued with a normal/passing Thyroid Profile 5. Identifies dogs that are phenotypically
$ 12.00
Thyroid Profile 4 PLUS WHOLE BLOOD & SERUM NEEDED (T4, Free T4, T3, Free T3 - PLUS CBC, Differential , Chemistries)
Formerly the D1
$ 145.00
Thyroid Profile 4 (T4, free T4, T3, free T3)
$ 85.00
Thyroid Profile 2 (T4, Free T4)
Formerly the 44
$ 75.00
OFA Thyroid Registry (free T4 ED, TSH, TgAA) ($105 test + separate $15 check)
$ 105.00
OFA Thyroid (Expanded Profile: T4, T3, free T3, T4AA, T3AA and OFA (FT4ED, TSH, TgAA) $130 test + separate $15 check)
$ 130.00
CBC, Differential, Chemistries WHOLE BLOOD & SERUM NEEDED
$ 76.00
Heartworm Antigen
$ 12.00
Distemper & Parvo Vaccine Titers
$ 52.00
Rabies Titer RFFIT (Not for travel) Measures response to rabies vaccinations.
$ 98.00
FAVN - Rabies (for pet travel to Rabies free countries or regions) Please include separate FAVN form with sample.
$ 120.00
von Willebrand Test Plasma from citrate tube (Blue top) needed.
$ 80.00
Phenobarbital DO NOT USE A SERUM SEPARATOR TUBE WITH GEL BARRIER
$ 70.00
Bromide DO NOT USE A SERUM SEPARATOR TUBE WITH GEL BARRIER
$ 80.00
ADD ON TSH
$ 22.00
ADD ON TGAA
$ 25.00
Consultation Request Only (with Dr. Dodds)
$ 100.00
NutriScan (24 foods) Includes kit with saliva collection instructions at no additional charge.
$ 280.00
ADDITIONAL DONATION TO HEMOPET$
TOTAL$ 0.00
Please remember that your veterinarian has professional time and overhead costs.

NUTRISCAN: Bulk purchases will be useful for veterinarians to keep in stock and for kennel clubs and health clinics run by clubs. Please contact us for Bulk purchases at nutriscan@hemopet.org or call 714-891-2022 option 3.

NUTRISCAN: Return mailing to Hemopet needs to be in a protected package or envelope. No refrigeration is necessary, and the saliva sample is viable for up to 30 days; however we do recommend that the sample should arrive at Hemopet within 10 days of being taken.

Other Tests

Payment methods accepted: check, creditcard or moneyorder.
Please make check or moneyorder out to "Hemopet" and include in package along with sample(s) when sending.

Credit Card # Type
Name as appears on card Expiration Date
Security Code
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