Culture Collections

Human Genetic Services Deposit Form

 

Please complete the following as fully as possible for each sample deposited with ECACC Genetic Support Services. Any high risk samples will be disposed of immediately without processing






PLEASE NOTE: ECACC is no longer able to store depositors samples long term free of charge. Depositors will be charged for storage on a per ampoule per year basis; alternatively, if requested, all ampoules will be returned to the depositor at their cost.

A. Contact Details

Please enclose copy of REC (Research Ethics Committee) approval or email to culturecollections@phe.gov.uk.

Please enclose copy of purchase order or email to culturecollections@phe.gov.uk.

B. Donor Details
C. Patient Consent

I have obtained consent from the patient for this blood sample to be stored at the ECACC Human Genetic Repository. I have explained that this sample may be transformed into a permanent cell line, which may be made available to qualified investigators for research, teaching or diagnostic purposes. I have explained that DNA extracted from this blood sample may be analysed for research, teaching or diagnostic purposes.

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