Sample availability request form

Researchers can easily obtain information on the number of registered samples from cancer patients in the Catalogue of the Belgian Virtual Tumourbank (BVTc) by completing this form.

(* = mandatory field) 


First name:  *
Surname:  *
Function:  *
E-mail:  *
Telephone:  *
Affiliation (full name and adress):  *
Topography ICD-O-3 code(s):   
Morphology ICD-O-3 code(s):   
Number of patients:   
Conservation mode: 

If other conservation mode is selected, please specify:   
Required human material type(s):   
Number of samples (amount) per patient:   
Age range:   
Exclusion criteria (if any):   
Any other specific requirements (if any):   
Title of the project:  *
Brief description of the project (max. 1 page):  *
Are there other (academic/industrial) partners involved in the project? If yes, please specify:  *