Division of Laboratory Animal Medicine

Surgery Suite Request Form

Requests should be submitted at least two weeks before date requested.

All USDA survival surgeries must be performed in the DLAM surgery suite 1666A. The suite must be booked in advance to guarantee your time requested. If there is a change in the date or time of the requested slot, a revised form must be submitted. The surgery suite, as well as assistance from the veterinarian and the veterinary technician, are billed per hour. If controlled substances are needed, a controlled substance request form must also be completed.

Contact Cassie Vorachek (by phone at 5-8599 or email at cvorachek68@siumed.edu if you have any questions.

Lab Personnel: Fill out entire form and attach in an email to your fiscal officer.

Fiscal Officer: Please add AIS account number, approve charges, and forward to

ResearchCores@siumed.edu.

Contact Person
Principle Investigator
Protocol #
Lab Room #
Phone #
AIS Account #
Dates Requested
Start Time
Approx End Time
Will you need assistance by the veterinarian? If so, approx how long?
Will you need assistance by the veterinary technician? If so, approx how long?
Do you need DLAM to order any supplies for the surgery?