AniCell Stallion Field Study Application

AniCell Stallion Field Study Application

AniCell Stallion Field Study Application

Please complete the Stallion Field Study Application. We will evaluate the application and give you a call to coordinate the treatment process to be performed.

Veterinarian*
Prefix First Last Suffix
Contact Type*
Email*
Cell Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Horse Custodian Name (Owner, Lessee, Farm Manager, Other)*
Stallion Name or Barn Name*
Breed
Age
Approximate Weight
Date of Diagnosis*
MM slash DD slash YYYY
History*
Please complete a full history. List any illness or injuries that might be relevant. Has the stallion ever been successful at breeding?
Diagnosis*
Is the stallion current on all of his vaccinations?*
File upload for additional information
Drop files here or

Max. file size: 64 MB.
Phase II Stallion Reproductive Health Field Trial Client Consent Form*
I (Stallion Owner/Custodian) consent to the Stallion Repro Health Trial.
Title: Field efficacy of Amnion on improving Semen Health

Principal Investigator: Dr. Chris Bradley, PhD, cbradley@anicellbiotech.com, 480-477-0105

AniCell Biotech’s mission is safely preserving ACTIVE life through the development of safe and quality products that promote tissue regeneration. Based on your expertise in the role of reproductive medicine, you are invited to participate in this mission by enrolling your animal in a clinical research study. Your participation is entirely voluntary, and you may withdraw your animal from the study at any time by notifying the Principal Investigator. There is no penalty if you choose not to participate.

Study Purpose:
To understand the effectiveness of using an unadulterated equine amnion-derived product (UEADP) to improve reproductive health in stallions.

Study Design/Procedures:
AniCell will supply a single IV administered UEADP for use on a stallion with chronic reproductive health issues. Four semen collections will be required at the following intervals:
(1) prior to application
(2) four-weeks post
(3) eight-weeks post
(4) twelve-weeks post

Risks and Benefits:
Suffice it to say, there are risks with any product usage. Fortunately, to date, there has not been a single severe adverse event ever documented in any of the literature over the past 108 years of recorded usage. As for our AniCell intravenous application of the products, there has not been a single safety event in the over one hundred applications performed in the last two years. The phase one trial did show significant results.

Study Costs and Compensation:
The amnion product to be used has been discounted to half-price ($1450). The veterinarian’s administration of the product and lab work to be performed will be done at normal costs.

Confidentiality:
The data collected in the course of this study is confidential. In any publication or presentation of the study data, we will not include information that would make it possible to identify a research participant. Research records will be kept in a locked file; only researchers will have access to the records.

Statement of Consent:
In giving my consent by signing this form, I acknowledge that I have been informed of the purpose, nature and risks of this study and its associated procedures, as well as any possible side effects.
I have read and understood the above information. I have been given the opportunity to ask questions and receive answers, and I consent to participate in the study. I further certify that I am the owner (or duly authorized agent of the owner) of the stallion listed above.

Please don’t hesitate to contact us if you have any questions or concerns about this study.
If you have any questions or concerns regarding the study and would like to talk to someone other than the researchers, please contact:

Brandon Ames, CEO
145 S. 79th St.
Chandler, AZ 85226
Mobile: 602-918-2637 ● 888-918-2637
www.anicellbiotech.com
brandon@anicellbiotech.com

You will be given a copy of this form to keep for your records.