Biobank registry form

Biobank / Lab Name*
Biobank objective / description:
Principal Investigator*
Title First name Last name
Does your biobank collect samples from participants with normal healthy skin?*
- yes
- no
Please list the skin conditions represented in your biobank:*
Please indicate anatomic sites from where the specimens are collected:
What specimen types are stored in your biobank (select all that apply)?
Specimen type - Tissue
- Fresh
  Frozen
  OCT TM embedded
  Formalin Fixed Paraffin Embedded (FFPE)
  Other
- Please specify if other
Specimen type - Cell & Cell lines
- Fresh (live viable cells)
  Cryopreserved cells
  Cell extracts for analyses
Specimen type - Blood & Blood derivatives
- Whole blood
  Fluid derivatives (plasma, serum)
  Cellular derivatives - Peripheral blood mononuclear cells
Specimen type - Other derivatives
- RNA
  DNA
  Free circulating nucleic acid (fcDNA and fcRNA)
  Protein isolates
  Histology slides
Specimen type - Swabs
- Traditional Microbiology
  Genomic Analysis
Specimen type - Other
- Urine
  Saliva
  Other
- Please specify if other
Location - City*
Location - Province*
Name of the biobank contact (if different than PI)
Title First name Last name
Contact Email for biobank enquiries:*
Enter Email Confirm Email
Submitted by:*