Clinical Laboratories
Order Form

Community Physician Office Supply Order Form

Community office personnel: Please complete the following form to request supplies.

Thank you.

* fields are required  

Contact Information

How Supplied:
Quantity Requested:
PK (10) Plates
PK (10) Plates
PK (50) Swabs
Each
Box (100) Swabs
Box (20) Vials
Box (20) Vials
Each
Each
Each
Each
50 Test Kits/package
50/pk
Each


Each or Case of 300
Each
Each
Each
Each


Pack (100) Cards
Bag (250) Adapters
Box (25) Tourniquets
PK (50) Extenders
Box (25) Warmers


20/Pkg
20/Pkg
20/Pkg


Box (200) Lancets
Box (200) Lancets
Bag (50) Tubes
Bag (50) Tubes
Bag (50) Tubes
Bag (50) Tubes
Tray (100) Tubes
Tray (100) Tubes
Tray (100) Tubes
Tray (100) Tubes
Tray (100) Tubes
Tray (100) Tubes


PK (100) Bags
PK (100) Bags
Pad (50 Forms)
Pad (50 Forms)