Type of Tissue Preparation Service From

Name of Investigator

Name of Organization

Email

Fax Number

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Tissue Being Processed

Unfixed

Fixed-Perfusion

Fixed-Immersion

Other

Will the sample be used for stereology analysis?

Yes

No

Type of Tissue Preparation

Tissue Cryoprotection & Freezing

Cryostat Sectioning

For Cryostat Sectioning (if applicable), please specify your desired thickness for each section (µm), distance between two stained sections (µm), number of sections (not slides) per region in the brain and number of regions per brain.

Plane of section

Coronally

Sagittally

Horizontally

Embedding Tissue in Paraffin

For Embedding Tissue in Paraffin (if applicable)，please specify the approximate tissue size for paraffin embedding (L × W × H) in µm,

Paraffin Sectioning

For Paraffin Sectioning (if applicable), please specify your desired thickness for each section (µm), distance between two stained sections (µm), number of sections (not slides) per region in the brain and number of regions per brain.

Plane of section

Coronally

Sagittally

Horizontally

Additional Information: