Client Supply Order Form

Client Supply Web Order Form

Please complete the form by entering the desired quantity of each supply. When finished click the "Submit" button. You will receive an email confirmation that your order has been placed.

Client Name*

Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Fax Number

Area CodeFax Number

E-mail

CYTOLOGY SUPPLIES

Frosted Slides (Box of 72)

Quantity

ThinPrep Pap Collection Vial (package of 25)

Quantity

Cyto-broom (package of 25)

Quantity

Cyto-brush/spatula, plastic (package of 25)

Quantity

Cytology Fixative Spray

Quantity

Cytolyte Specimen Container (single)

Quantity

Cytolyte Specimen Container (package of 25)

Quantity

BIOPSY SUPPLIES

Biopsy specimen container A (20mL)

Quantity

Biopsy specimen container A (20mL) case of 256

Quantity

Biopsy specimen container B (60mL)

Quantity

Biopsy specimen container B (60mL) case of 256

Quantity

Biopsy specimen container C (120mL)

Quantity

Biopsy specimen container C (120mL) case of 96

Quantity

Biopsy specimen container D (240mL)

Quantity

Biopsy specimen container D (240mL) case of 50

Quantity

Small container with lid -A (4 oz.)

Quantity

Small container with lid -B (16 oz.)

Quantity

Medium container with lid -C (32 oz.)

Quantity

Large container with lid -D (.5 gal.)

Quantity

Jumbo container with lid -E ( 1 gal.)

Quantity

Screw top container with lid (1000mL(32oz.))

Quantity

Bulk Formalin (1 gal)

Quantity

Bulk Formalin (5 gal)

Quantity

B Plus Solution (20mL)

Quantity

RPMI Media (15mL tube)

Quantity

RPMI Media (100mL bottle)

Quantity

Decalcifying Solution (1 gal, box)

Quantity

Michel's IF Fixative (Zeus, 5mL bottle)

Quantity

Michel's IF Fixative (Zeus, box of 50)

Quantity

Transport Supplies

Biohazard Specimen Bags (6 x 9), single

Quantity

Biohazard Specimen Bags (6 x 9), box of 100

Quantity

Biohazard Specimen Bags (8 x 10), single

Quantity

Biohazard Specimen Bags (12 x 16), single

Quantity

Dri-Mop Pads, single

Quantity

Padded Mailing Envelopes, single

Quantity

Postage-paid Mailing Labels, single

Quantity

Flow Specimen Mailers, single

Quantity

Fedex Airbills

Quantity

FedEx Clinical Paks

Quantity

FedEx Small Shipping Boxes

Quantity

Mailing Canisters

Quantity

Slide Holder, single (holds 2 slides)

Quantity

Slide Holder, multi (holds 5 slides)

Quantity

COVID collection kit

Quantity

Forms

Surgical Pathology Requisition Preprinted with Client/Physician Name and Address (regular req.)

Quantity

Oncology Requisition Preprinted with Client/Physician Name and Address

Quantity

Women’s Health Testing Requisition with Client/Physician Name and Address

Quantity

Frozen Section / Immediate Diagnosis requisition

Quantity

IHC Requisitions

Quantity

CMS Advance Notice Beneficiary

Quantity

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