Please fill in the below form or attach a gross necropsy report with any post mortem samples. If a tissue or site was not examined, please enter “NE” in description or leave empty

Clinic Name (*):

Patient First Name (*):

Patient Last Name (*):

Was the animal euthanized? If so, what method?

Date and time of death (*):

Date and time of necropsy (*):

BODY WEIGHT (in kg)

GENERAL CONDITION (Nutritional condition, physical condition, BCS)
Neonates: examine for malformations (cleft palate, deformed limbs, etc) :

SKIN (Including pinna, feet):

MUSCULOSKELETAL SYSTEM (Bones, joints, muscles):

BODY CAVITIES (Fat stores, abnormal fluids):

HEMOLYMPHATIC (Spleen, lymph nodes, thymus):

RESPIRATORY SYSTEM (Nasal cavity, larynx, trachea, lungs, regional lymph nodes):

CARDIOVASCULAR SYSTEM (Heart, pericardium, great vessels) :

DIGESTIVE SYSTEM (Mouth, teeth, esophagus, stomach, intestines, liver,
pancreas, mesenteric lymph nodes):

URINARY SYSTEM (Kidneys, ureters, urinary bladder, urethra):

REPRODUCTIVE SYSTEM (Testis/ovary, uterus, vagina, penis, prepuce,
prostate, mammary glands, placenta):

ENDOCRINE SYSTEM (Adrenals, thyroid, parathyroids, pituitary):

SAMPLES COLLECTED (Please list all samples collected for histology):