Lab Supply Order Form
Fill out and submit the order form below and we’ll confirm your order before we fulfill it.
Full Name
*
First Name
Last Name
Client Name
*
Company
*
Phone Number
*
-
Area Code
Phone Number
E-mail
Back
Next
Surgical Pathology
20 ml Formalin bottles (96/box)
Quantity ---------------
20 ml Formalin bottles (500/box)
Quantity ---------------
40 ml Formalin bottles (96/box)
Quantity ---------------
60 ml Formalin bottles (96/box)
Quantity ---------------
RPMI Tissue medium (Flow cytometry specimens)
Quantity ---------------
Sterile specimen Cups, 90ml (tissue culture, urine cytology)
Quantity ---------------
2.2L empty containers (w/lid)
Quantity ---------------
480ml empty containers (w/lid)
Quantity ---------------
1Gal. Bottle of Formalin
Quantity ---------------
Michel's Media (DIF specimens)
Quantity ---------------
Clinical Pathology
Urine Culture Straw Kits 50/Box
Quantity ---------------
Bacterial Culture Swabs 50/Pk
Quantity ---------------
SST tubes 100/pk
Quantity ---------------
EDTA tubes 100/pk
Quantity ---------------
Blood Draw Needles
Quantity ---------------
Urology
Prostate biopsy kit (12 bottles /kit)
Quantity ---------------
Transport/Documentation
Small specimen bags, 6" x 9" (Zip-loc style)
Quantity ---------------
Large specimen bags (adhesive close)
Quantity ---------------
Pathology requisitions - Maryland (100/pack)
Quantity ---------------
Pathology requisitions - Virginia (100/pack)
Quantity ---------------
Locking specimen box
Quantity ---------------
Comments, questions or special instructions?
Place Order
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm