Piedmont Scrubs & Uniform Order Form

Browse our catalog for style details and fill in the order form below. After submission, our team members will reach out to confirm your details within 1 business day.

Name

First NameLast Name

Department or Company Information

Email Address*

example@example.com

Contact Number*

Please enter a valid phone number.

Select your products of choice.

Women's Catarina™ One-Pocket Scrub Top

$32.30

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Forest Green
Other

Item subtotal:$0.00

Women's Rafaela™ Oversized Scrub Top

$32.30

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Forest Green
Other

Item subtotal:$0.00

Women's Casma™ Three-Pocket Scrub Top

$32.30

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Forest Green
Other

Item subtotal:$0.00

Women's Livingston™ Basic Scrub Pants

$37.40

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Black
Other

Item subtotal:$0.00

Women's Kade Cargo Scrub Pants

$40.80

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Black
Other

Item subtotal:$0.00

Women's Zamora™ Jogger Scrub Pants

$40.80

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Black
Other

Item subtotal:$0.00

Men's Leon™ Three-Pocket Scrub Top

$32.30

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Forest Green
Other

Item subtotal:$0.00

Men's Chisec™ Three-Pocket Scrub Top

$32.30

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Forest Green
Other

Item subtotal:$0.00

Men's Leon™ Cargo Scrub Top

$40.80

Color	Quantity	Size
Navy
Black

Item subtotal:$0.00

Men's Pisco™ Basic Scrub Pants

$37.40

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Black
Forest Green
Other

Item subtotal:$0.00

Men's Cairo™ Cargo Scrub Pants

$40.80

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Black
Forest Green
Other

Item subtotal:$0.00

Men's Tansen™ Jogger Scrub Pants

$40.80

Color	Quantity	Size
Navy
Ciel Blue
Graphite
Black
Forest Green
Other

Item subtotal:$0.00

Total

$0.00

Additional Comments

Piedmont Medical Scrubs & Uniform Order Form