PHARMACEUTICAL REQUEST FORM
DIVISION OF LABORATORY ANIMAL HEALTH
311 Greene Hall Annex
844-5667

Pharmaceutical Request Forms are used when an investigator needs to procure a pharmaceutical agent for use on an IACUC approved protocol.  This form my be submitted online, by fax (4-0462), campus mail, or hand delivered.  If submitted online, you will receive a confirmation of receipt via email.

PRINCIPAL INVESTIGATOR:

DEPARTMENT:

IACUC PRN:

PHARMACEUTICAL(S) NEEDED:

CONCENTRATION:

AMOUNT:(i.e., 200cc bottle, 2cc in a syringe, etc.)

DATE PHARMACEUTICALS REQUIRED:

EMAIL ADDRESS:

Note - All controlled substances must be picked up by a faculty member associated with the project. The faculty member designated to pick up the pharmaceuticals will need to sign them out at the Division of Laboratory Animal Health.