Please provide the following information on your organization’s Letterhead if you need to submit a specimen request for your lab activity.
Specimen Request Letter
Please note: 1 letter per project/course
1. Time period (date needed by; how long project will be active)
2. Researcher names
3. Purpose of research study or training
4. How specimens will be used/examined
5. Anatomy requested (be specific, noting exclusion criteria, etc.):
6. Total number of specimens
7. Complete billing information, including federal ID number
8. Location where specimen will be disposed:
Stericycle, Inc. – Lakeland, FL, per arrangement with University of Florida Department of Orthopaedic Surgery and Sports Medicine
9. Delivery location where study/course will be conducted:
UF Orthopaedics Surgical Skills Lab
3450 Hull Road, Room #4301
ATTN: Chris Koenig – 352-318‐0524
Gainesville, FL 32607
Required Signature: (include their printed name, their signature, and the date)
Researcher Actively in Charge of Study/Course and Responsible for Charges
Return the Above Information completed on Organizational Letterhead to:
UF Orthopaedic Surgery and Sports Medicine
ATTN: Chris Koenig
PO Box 112727
Gainesville, FL 32611
352-318‐0524 voice
koenicj@ortho.ufl.edu