Animal Tissue Form

 

The Natural Health Products Directorate (NHPD) has changed its name to the Natural and Non-prescription Health Products Directorate (NNHPD) subsequent to its recently expanded mandate to include the oversight of non-prescription and disinfectant drugs in addition to natural health products (NHPs). Please note that we are currently modifying documents to reflect this change.

Thank you for your patience and understanding.

This HTML document is not a form. Its purpose is to display the information as found on the form for viewing purposes only. If you wish to use the form, you must use the alternate format below.

For Viewing Purposes Only - Licence applicants must use the available WORD or PDF versions of this form when submitting it to the Natural Health Products Directorate (NHPD).

Protected when completed

1. - Ingredient derived from animal tissue:

  • Name:

2. - Used as

  • Ingredient OR
  • in processing of product

3. - Animal species

  • cattle
  • pig
  • deer or elk
  • poultry
  • sheep
  • crustacean
  • goat
  • Other:

4. - Animal tissues used

  • adipose tissue/omentum
  • antler velvet
  • appendix
  • bile
  • blood/blood products
  • bones (other than vertebral column)
  • brain
  • colostrum
  • dorsal root ganglia
  • dura mater
  • enzymes
  • eyes/corneas
  • heart/pericardium
  • intestine
    • small
    • large
  • kidney
  • lung
  • mammary gland
  • milk and milk products
  • muscle, skeletal
  • ovary
  • pancreas
  • pituitary
  • saliva, salivary gland
  • skin/hides
  • skull
  • spinal cord
  • spleen
  • tendons, ligaments
  • testis
  • thymus
  • thyroid
  • tonsils
  • trigeminal ganglia
  • vertebral column
  • Other:

If you checked cattle; deer or elk; sheep; or goat, in section 3 please fill in the following two sections. (5. & 6.)

5. - What is (or will be) the age of the animals used?

Under:
or Range from:
to:

6. - Country/Countries from which the animals originated (or will originate)?

  • Argentina
  • Australia
  • Brazil
  • New Zealand
  • United States
  • Uruguay
  • Other:

Signing Authority

I am aware that the above information may be used to conduct a risk-based assessment before any decision is taken with regard to the accompanying Product License application. I agree that if the company changes either the source or the type of animal sourced material used in the product prior to or after receiving final approval for a product submission, it must submit an Amendment of Product License form to the Natural Health Products Directorate of Health Canada.

  • Signature:
  • Date (yyyy-mm-dd):
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