Form 15F Swab

The purpose of this simple procedure is to collect some loose cells from your
mouth. Please follow the instructions below. You may request help reading the
instructions from a member of your household, but please do not permit
anyone else to handle the collection materials.
Here is a list of what you should find in the enclosed envelope:
• Two copies of the Informed Consent Form
• Screw top collection container
• Plastic bottle of mouthwash
• Leak-proof plastic bag with a small absorbent sheet (in case anything spills)
• Pre-stamped mailing envelope
INSTRUCTIONS FOR BUCCAL CELL COLLECTION
1.

Read and sign one copy of the Informed Consent Form. (The
other copy is yours to keep.)

2.

Do not eat or rinse your mouth for one hour before collecting
the sample.

3.

Open the bottle of mouthwash and fill the enclosed container
with mouthwash to the red line.

3. Fill to red line

4.

Swish the mouthwash from the container around in your mouth
vigorously for 45 seconds. Watch the clock while you do this.

4. Swish for

5.

Holding the container close to your mouth, spit the mouthwash
back into the container. Replace the top on the container and
screw it on tightly. You may keep the remaining portion of
mouthwash for your own use.

5. Spit and Close
the top tightly

1. Sign Informed Consent
2.

45 seconds

INSTRUCTIONS FOR MAILING
Prepare the collection container for mailing as follows:
1.

Make sure the Informed Consent Form with your signature is
placed in the padded envelope.

2.

Place the collection container into the leak-proof plastic bag.
Keep the absorbent sheet in the bag. Remove any air from the
bag and seal the bag.

3.

Place the plastic bag and its contents into the padded envelope
that is addressed to the biorepository. Seal the envelope.
Mail the samples within 24 hours of collection.

4.

If you have any questions or concerns, please call us at 1-800-424-7883.

one hour!

Thank you!