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Specimen Submission Forms

Environmental Sample for Biological Threat Agent Testing Submission Form
For law enforcement use only.

Influenza Specimen Collection and Submittal Instructions(PDF: 139 Kb)
Use this form to submit all influenza specimens, including A(H3N2)v.

Lyme Organism in Ticks (PDF: 191 Kb)
Use this form to submit tick specimens for testing.

Monster Form(PDF: 152 Kb)
Use this form to submit all types of specimens.

Tick-borne Disease Serology(PDF: 108 Kb)
Use this form for tick panel tests.

Water Testing Lab Slip (PDF: 218 Kb)
Use this form for all water testing.

Multiple Water Samples Submission Form (PDF: 63 Kb)

Shellfish Growing Waters Sample Submission Form (PDF: 95 Kb)

West Nile virus Infection Case Report (PDF: 96 Kb)
Include this form with the West Nile virus Specimen Submittal Form when submitting specimens.

West Nile virus Specimen Submittal Form (PDF: 171 Kb)
Use this form to submit West Nile virus specimens.

Zika virus disease –Use these forms to submit Zika virus specimens.

Zika Virus Testing Criteria & Instructions Form (PDF: 161 Kb)

Zika Virus Testing Criteria & Instructions Form-Mother Post Delivery (PDF: 519 Kb)

Zika Virus Testing Criteria & Instructions Form-Infant Post Delivery (PDF: 158 Kb)

Contact Information

Public Health Regional Laboratory

Public Health Division

Health Services

Contact us by Phone

Address

3313 Chanate Road

Santa Rosa, CA 95404

Fees for Testing Services