I hereby certify that the sample submitted is of the animal described on this application and that this animal has not received thyroid medication of any type for 3 months prior to this test. I understand that only normal results will be released to the public unless the initials of a registered owner appear in the authorization box below which permits the OFA to release abnormal results to the public.

Fees

Animals Over 12 Months
• Thyroid database............... $15.00
• Litter of 3 or more submitted together............... $30.00

Kennel Rate—Individuals submitted as a group, owned/co-owned by same person.
• Minimum of 5 individuals.................. $7.50 per study

Exams on animals under 12 months of age are considered preliminary evaluations and are not eligible for OFA numbers