PathAdvantage Client Supply Order Form
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Full Name
*
First Name
Last Name
E-mail
*
Contact Number
*
-
Area Code
Phone Number
Clinic Name
Please Select
AA OBGYN Clinic
Abilene OBGYN Assoc. Bldg. 1904
Abilene OBGYN Assoc. Bldg. 1924
Adriatica Women's Health - McKinney
Adriatica Women's Health - Prosper
Advanced Gynecology and Wellness, PA
Advanced OB-GYN Associates
Alinsod Institute of Aesthetic Vulvovaginal Surgery
Alive and Well
Allen OBGYN
Amy G. Martin, MD
Anne Coleman, MD
Antonio A Castaneda, MD
ATA Health and Wellness
Axmann & Whitaker Gynecologic Assoc
Azure Med Spa
BSW - Centennial Frisco
BSW - FMC Mesquite
BSW - FMC Murphy
BSW - FMC North Garland
BSW - FMC Rockwall
BSW - Garland
BSW - Grapevine
BSW - Grapevine - Dr. Kilianski
BSW - WHG - Dallas
BSW - OBGYN Rockwall
BSW - Park Lane OBGYN Associates
BSW - Plano
BSW - Rowlett
BSW - Waxahachie
BSW MSCI OB/GYN - Frisco
BSW OBGYN - Frisco PGA
Bloom Gynecology
Brownwood Women's Clinic
Caring for Women - Denton
Caring for Women - Flower Mound
Caring for Women - Frisco
Caring for Women - Lewisville
Carlos & Parnell, M.D. P.A.
Carolyn W. Quist, DO
CarPathia Collaborative
Carter, Hays, Powers and Associates LLP
Catherine Holt, MD & Jordan Mitchell, MD
Center of Hope - Dallas
Central Texas Medical Clinic
Christopher Petr, MD
Christy W Walker, MD
Complete Women's Care
Comprehensive OBGYN - Medical Center
Comprehensive OBGYN - Lake Forest
Connie Casad, MD
Contemporary Women’s Care
CornerStone MD
Crossroads Women's Health
Dallas Fort Worth Fertility Associates - Dallas
Dallas Medical Specialist at Medical City
Dallas OBGN PA
Dallas Obstetrics and Gynecology - Dr. Fuller
Dallas Women's Healthcare Specialist, PLLC
Denton Obstetrics and Gynecology, PA
Discovery Clinical Trials
Divine Design Wellness
Doreen Moser, DO
Dr. Bob Smith Health Center (SMU)
Cheryl Kinney, MD
Edward L. Holt, DO
Emil W Tajzoy, MD
Endometriosis Center of Excellence
FEM Centre - Colleyville
FEM Centre - Fort Worth
Flower Mound Women's Care
David Fong, MD
Frisco OBGYN
Gary Duncan, MD
Glow OBGYN - Theresa M Conyac, MD
Gynecology & Women’s Health - Dr. Sudela
H. A. Grand, MD
Hampton Medical Clinic
Health Central Women’s Care - Dallas
Health Central Women's Care - Sachse
Her Complete Healthcare
Hillcrest Family Medicine
Hope Internal Medicine Clinic
Indrani Reddy, MD - Denton OBGYN PA
Indrani Reddy, MD - MCSD Surgery Center
Intricate Health
IVF Institute
Jennifer Gulick, MD and Alisa Ward, MD
Kamilia T Smith, MD
Kinwest OBGYN - Jose F. De Leon, MD
Lake Pointe Women's Center - Forney
Lake Pointe Women's Center - Rockwall
Lake Pointe Women's Center - Rowlett
Lakeside Physicians OBGYN - Stephenville
Lakeside Physicians OBGYN - Granbury
Las Colinas OBGYN
Lauren Monti, MD
Legacy OBGYN
Lewisville Women's Care
Magnolia OBGYN
Marcia J Oliveira, MD
Mayra J Thompson, MD PLLC
MD Progressive Care
Medtopia Medical Clinic
Meredith McClure MD
Methodist - Arlington South
Methodist - Charlton
Methodist - Mansfield Broad St #100
Methodist - Mansfield Broad St #212
Methodist - Midlothian
Methodist - Richardson
Methodist - Waxahachie
Methodist - WHS Celina
Methodist - WHS Dallas
Michael W. Jones, MD
Midwife+Co - Dallas
Midwife+Co - Fort Worth
Midwife+Co - Henderson
Nathan T. Thomas, MD
North Dallas Urogynecology
North Texas Colon and Rectal - Dallas #600
North Texas Women's Healthcare Assoc. - Ft Worth
NTX Gynecologic Oncology - Dallas
NTX Gynecologic Oncology - McKinney
NTX Gynecologic Oncology - Plano
North Texas Infectious Diseases - North
North Texas Infectious Diseases - South
North Texas Medical Center
North Texas OBGYN Assoc. - Flower Mound
North Texas OBGYN Assoc. - Lewisville
NTPHP - Dallas Junius
Northlake OBGYN - Dallas
Northlake OBGYN - Frisco
Northlake OBGYN - Plano
Northshore Wellness & Weight Loss
Noushin A. Firouzbakht, MD
Nurture Women's Health
Oak Hills Med Spa and Wellness Center
OB/GYN Specialists of Denton (Alliance OBGYN Specialists)
OBGYN Associates of North Dallas
Obstetrics & Gynecology Associates - Flower Mound
Obstetrics and Gynecology Associates of Dallas
OBGYN Infertility - Jon Ricks, MD
Ovation OBGYN
Patrick Allen, MD
Pearl Women's Health & Surgery
Pediatricians of Dallas
Pelvic Rehabilitation Medicine
Peter J. Irwin, M.D.
Premier OBGYN Center
Premier Wellness Internal Medicine
Prism Health North Texas - Oak Cliff Health Center
Prism Health North Texas - Oak Lawn Health Center
Prism Health North Texas - South Dallas Health Center
Prism Health North Texas - Uptown Physician Group
Prism Health North Texas - Worth Street Health Center
Prosper Women’s Health
Quanita Crable, MD
Radford and Associates
Radiant Life Wellness and Aesthetics
Rhodesia LaStrap, DO
Roots Integrative Gynecology - Odette Limosnero, MD
Serenity Gyn & Functional Med
Southern Charm Women's Health
Specialty Care Clinic - Lancaster #370
Specialty Care Clinic - Plano
Specialty Care Clinics - Little Elm
Stella Matina- Dallas - Dr. Jorge Lopez
Stella Matina - Rockwall
Steven Pounders, MD
Swiss OBGYN
Tara Dullye, MD
Ted E Fogwell, MD
Texas Oncology #140
Texas Health Care - Seasons OBGYN
Texas Health Care - 8th Ave #320 (Fenom)
Texas Health Care - 8th Ave #430
Texas Health Care - 8th Ave #435
Texas Health Care - 8th Ave #440
Texas Health Care - 8th Ave #445
Texas Health Care - Barwick Dr.
Texas Health Care - Beach St.
Texas Health Care - NTWH - FW #280
Texas Health Care - NTWH - Keller
Texas Health Care - Granbury
Texas Health Care - (Willow Park) Lone Star Medical Plaza
TXHC - Natalie Hughes, DO
THMA - Lone Star Rd. #200
THMA - Lone Star Rd. #220
THMA - Lone Star Rd. #260
THMA - Cedar Hill
THMA - North Miller Rd, Mansfield #100
Texas Health Women's Care Clinic #110
THPG - Alliance Fort Worth #250
THPG - Alliance Women's Healthcare
THPG - Cleburne
THPG - Denton North
THPG - Frisco - Dr. Boyd
THPG - Grand Prairie
THPG - OBGYN Associates Dallas #100
THPG - Mid Cities OBGYN
THPG - Nurse Midwife Care
THPG - Parker Rd
THPG - Stephenville
THPG - Fort Worth - W Terrell
THPG - Walnut Hill #116
THPG - WHS of Dallas #200
THPG - WHS -Rockwall
Texas Obstetrics and Gynecology - Dr. Branning
Texas Oncology #140
Texas Premier OBGYN Center
Texas Specialty Clinic - Lancaster #340
TexomaCare - OBGYN #210
TexomaCare - OBGYN #250
TexomaCare - OBGYN #300
The Drip Bar
The Gynecology Spot
The North Texas Center for Women’s Health
The Rinnovare Institute - Dr. Liaci
The Stoehr Center
Total Women’s Care of North Texas
Urology Clinics of North Texas
Vernon & Waldrep OBGYN Associates
Waco Center for Women's Health
Waco Gynecology
Walnut Hill OBGYN #100
Walnut Hill OBGYN #200
Weatherford OBGYN Associates
White Rose Women's Center
Wise Health Clinics OBGYN - Decatur
Wise Obstetrics and Gynecology
Women’s Health Services - Waldrop
Women’s Health Services - Grand Prairie
Women's Health Services - Cooper
Women's Health Alliance - Dallas
Women's Health Alliance - Mesquite
Women's Health Center - Mineral Wells
Women's Premier OBGYN
Women's Wellness Institute of Dallas
Wonderfully Made Functional Med - Kathryn Wood, MD
Yasmin Khan, MD
Clinic NAME
*
Doctors Office
Location
*
Street Address
City
State
Postal / Zip Code
Supply List
*
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Needles - 21 Gage 1 1/4" (48/pk)
$
Free
Quantity
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10
Needles - 21 Gage 3/4", 12" Tubing (50/pk)
$
Free
Quantity
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9
10
Needles - 23 Gage 3/4", 12" Tubing (50/pk)
$
Free
Quantity
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9
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Needles - 25 Gage 3/4", 12" Tubing
$
Free
Quantity
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10
Necessary Items - Specimen Labels
$
Free
Quantity
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Serum
Plasms
STAT
Frozen
GGT
Necessary Items - Printer Labels
$
Free
Size
Dymo 1" x 2-1/8"
Dymo 1-1/8" x 3-1/2"
TSE (Betckey) 3/4" x 2"
TSE (Betckey) 1-1/8" x 3-1/2"
Quantity
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2
3
Glucola Drinks - Fruit Punch 50 Gram (6/pk)
$
Free
Quantity
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Glucola Drinks - Lemon Lime 50 Gram (6/pk)
$
Free
Quantity
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Glucola Drinks - Orange 50 Gram (6/pk)
$
Free
Quantity
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Glucola Drinks - Fruit Punch 75 Gram (6/pk)
$
Free
Quantity
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Glucola Drinks - Lemon Lime 75 Gram (6/pk)
$
Free
Quantity
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Glucola Drinks - Orange 75 Gram (6/pk)
$
Free
Quantity
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Glucola Drinks - Fruit Punch 100 Gram (6/pk)
$
Free
Quantity
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Glucola Drinks - Lemon Lime 100 Gram (6/pk)
$
Free
Quantity
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Glucola Drinks - Orange 100 Gram (6/pk)
$
Free
Quantity
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Blood Collection Tubes - Red Cap/Yellow Ring 8 ml (50/Flat)
$
Free
Replacement for Tiger Tops (SST)
Quantity
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Blood Collection Tubes - Lavender Top 4.0 ml (100/Flat)
$
Free
Also Used for Carrier Panel
Quantity
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Blood Collection Tubes - Lavender Top 6.0 ml (NATERA)
$
Free
Quantity
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Blood Collection Tubes - Light Blue Top 2.7 ml
$
Free
Quantity
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Blood Collection Tubes - Light Green Top 3 ml
$
Free
Quantity
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Blood Collection Tubes - Royal Blue Top 6 ml No Trace
$
Free
Quantity
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Blood Collection Tubes - Royal Blue Top 6 ml EDTA
$
Free
Quantity
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Blood Collection Tubes - Red Top 10 ml
$
Free
Quantity
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Blood Collection Tubes - Pink Top 6 ml (100/flat)
$
Free
Quantity
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Blood Collection Tubes - ARUP Green Top 6 ml
$
Free
Quantity
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Blood Collection Tubes - ARUP Blue Top 4 ml (Trace Metal Free Pour Off)
$
Free
Quantity
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Blood Collection Tubes - Green Top 4 ml (Special Request)
$
Free
Quantity
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50
Blood Collection Tubes - Non-Invasive Prenatal Testing (CamoTop Vial)
$
Free
Quantity
1
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49
50
Necessary Items - Alcohol Prep Wipes
$
Free
Quantity
1
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6
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8
9
10
Necessary Items - Bandages
$
Free
Quantity
1
2
3
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5
Necessary Items - Tourniquets
$
Free
Quantity
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Necessary Items - Gauze
$
Free
Quantity
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Necessary Items - Paper Tape
$
Free
Quantity
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Necessary Items - Instant Hot Packs (Heel Warmers)
$
Free
Quantity
1
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Necessary Items - Ice Packs
$
Free
Quantity
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Instant Cold Pack
$
Free
Quantity
Necessary Items - Pour Off Tubes w/Caps (25/pk)
$
Free
Quantity
1
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Necessary Items - Adhesive Bandages (30/pk)
$
Free
Quantity
1
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Necessary Items - Sani-Cloths
$
Free
Quantity
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50
Sharps Container - 3 Gallon
$
Free
Quantity
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Sharps Container - 5 Quart
$
Free
Quantity
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Sharps Container - 1.5 Quart
$
Free
Quantity
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Necessary Items - Tube Holders
$
Free
Quantity
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Gloves (100/pk)
$
Free
Quantity
1
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48
49
50
Size
Extra Small
Small
Medium
Large
Extra Large
Molecular - BBL GBS Double Applicator - Red Top (50/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
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45
46
47
48
49
50
Molecular - BBL GBS Single Applicator - White Top (50/pk)
$
Free
Quantity
1
2
3
4
5
6
7
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9
10
11
12
13
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45
46
47
48
49
50
Molecular - BBL GBS Single Applicator - Blue Top (10/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
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45
46
47
48
49
50
PAP - ThinPrep Vials (25/flat)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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45
46
47
48
49
50
PAP - Brushes/Spatulas (25/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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44
45
46
47
48
49
50
PAP - Cervical Brooms (25/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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39
40
41
42
43
44
45
46
47
48
49
50
PAP - Brushes - No Metal Tip - Sterile (100/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
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39
40
41
42
43
44
45
46
47
48
49
50
PAP - Rovers Cervex Brush Combi (25/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
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34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Molecular - C&S Transfer Straw Kit (50/box)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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36
37
38
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40
41
42
43
44
45
46
47
48
49
50
Urine Collection - Sterile Urine Cups
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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37
38
39
40
41
42
43
44
45
46
47
48
49
50
Urine Collection - Non-Sterile Urine Cups
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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37
38
39
40
41
42
43
44
45
46
47
48
49
50
Urine Collection - Dixie Cups (100/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Urine Collection - Paper Cups (100/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Urine Collection - Urine Analysis Collection Tube 8 ml (Red and Yellow Top)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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40
41
42
43
44
45
46
47
48
49
50
Necessary Items - Pipet
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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40
41
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45
46
47
48
49
50
Urine Collection - 24-Hour Urine Jugs
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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18
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34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Urine Collection - Urine Collection Hats
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Urine Collection - Brown Paper Bags
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Molecular - BD Affirm Swab (10/box)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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35
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38
39
40
41
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43
44
45
46
47
48
49
50
Molecular - RapidfFN (FETAL FIBRONECTIN)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Molecular - Orange Aptima CT/GC Swabs (50/box)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Molecular - Yellow Aptima Urine Specimen Kit (50/box)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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36
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38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - 20 mL Formalin Containers (24/box)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - 40 mL Formalin Containers (24/box)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - 60 mL Formalin Containers (24/box)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Bags - Small 6x9 (100/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
Bags - Large Adhesive 15" x 17" (50/pk)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
Biopsy - ECC Cytostat Red Vials (25/tray)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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25
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30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - EMB Formalin Vials (25/tray)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - Soft ECC Brush Kits (Blue Device)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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25
26
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30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - Soft ECC Brush Only (Blue Device)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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25
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30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - Soft CX Brush Kits (Purple Device)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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25
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31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - Soft CX Brush Only (Purple Device)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - EMB Brush Kits (Pink Brush)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Biopsy - EMB Brush Only (Pink Device)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Molecular - BZK Antiseptic Towelette (1000/box)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Requisition Forms - GYN (Purple)
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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112
113
114
115
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128
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130
131
132
133
134
135
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138
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145
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147
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151
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177
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Requisition Forms - Clinical (Blue)
$
Free
Quantity
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Supply Item Not Listed - See additonal request below
$
Free
Total
$
0.00
Additional Requests
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