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Biospecimen Request Application

Biospecimen Request Application

Biospecimens are available to collaborating academic scientists free of charge and to industrial partners on a fee-for-service basis. Submit the application below to have a BioBank representative contact you to discuss your request. If approved, you may also be asked to complete a material use agreement and/or a data transfer agreement.

Please list the specific spediments and associated quantities needed. 

We/I agree that the samples provided by the Gundersen Medical Foundation BioBank will be used for the research work detailed in the this proposal. The material will not be used for other studies or distributed to third parties. We/I realize that there is the potential that this human biological material may contain infectious agents and, therefore, will handle it appropriately.

Enter your name below as your electronic signature to acknowledge that you agree and accept the terms as stated.

1900 South Ave.
La Crosse, WI 54601

(608) 782-7300

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