Client Supply Order Form

ATTENTION: As many other businesses, we are currently experiencing delays and shortages on a number of our very common supplies. We are doing our best to explore other options and substitute with comparable supplies where possible. Please be patient with our staff and be willing to be flexible as we all deal with this situation together. Please call us if you have concerns. Thank you!

Your Name*
Your Facility*
City*
Phone #*
Email Address
Bandage and Phlebotomy Prep
Alcohol Prep Pads [200/box] - Limit of 1
Price: $0.00 Quantity:
Bandage Co-flex 2 inch [36 rolls/case] - Limit of 1
Price: $0.00 Quantity:
Bandage Co-flex 1 inch [30 rolls/case] - Limit of 1
Price: $0.00 Quantity:
Cotton Balls [500/bag]
Price: $0.00 Quantity:
Needle Holder/Hub [50/pk]
Price: $0.00 Quantity:
Tourniquet [50 pcs]
Price: $0.00 Quantity:
Blood Collection Tubes
Small Purple Top, K2 EDTA 4ml [50/pk]
Price: $0.00 Quantity:
SST (Gold) [50/pk]
Price: $0.00 Quantity:
Large SST (Tiger) [50/pk]
Price: $0.00 Quantity:
Large Pink Top, K2 EDTA 6ml [50/pk] - Replaces Large 10 ml Purple top EDTA tubes.
Price: $0.00 Quantity:
Light Blue Top, Sodium Citrate - Please order the total number of tubes you need. [1 each]
Price: $0.00 Quantity:
Red Top, No Additive 10ml [50/pk]
Price: $0.00 Quantity:
Royal Blue Top, K2 EDTA Plasma [1 each]
Price: $0.00 Quantity:
Royal Blue Top, K2 EDTA Serum [1 each]
Price: $0.00 Quantity:
Tan, K2 EDTA [1 each]
Price: $0.00 Quantity:
Needles and Syringes
Needle Blood Collection 21g (Green Cap) [48/box]
Price: $0.00 Quantity:
Needle Blood Collection 22g (Black Cap) [48/box]
Price: $0.00 Quantity:
Needle, Butterfly 21g [25 /box]
Price: $0.00 Quantity:
Limit of 1 due to National Shortage
Needle, Butterfly 23g [25/box]
Price: $0.00 Quantity:
Limit of 1 due to National Shortage
Insulin Resistance Testing
Glucose Drink 100g Lemon Lime [6 bottles/pk]
Price: $0.00 Quantity:
Glucose Drink 100g Orange [6 bottles/pk]
Price: $0.00 Quantity:
Glucose Drink 100g Fruit Punch [6 bottles/pk]
Price: $0.00 Quantity:
Glucose Drink 75g Lemon Lime [6 bottles/pk]
Price: $0.00 Quantity:
Glucose Drink 75g Orange [6 bottles/pk]
Price: $0.00 Quantity:
Glucose Drink 75g Fruit Punch [6 bottles/pk]
Price: $0.00 Quantity:
Glucose Drink 50g Lemon Lime [6 bottles/pk]
Price: $0.00 Quantity:
Glucose Drink 50g Orange [6 bottles/pk]
Price: $0.00 Quantity:
Glucose Drink 50g Fruit Punch [6 bottles/pk]
Price: $0.00 Quantity:
Urine Collection
Urine Container 24 Hour Jug [1 bottle]
Price: $0.00 Quantity:
Urine Cups 90 ml [100 /pk]
Price: $0.00 Quantity:
Urine Specimen Hat [25/case]
Price: $0.00 Quantity:
Urine Towelettes [100/box]
Price: $0.00 Quantity:
Stool Collection
Occult Blood Card [1 each]
Price: $0.00 Quantity:
Culture Swabs
Amies Swab (Blue) [25/pk]
Price: $0.00 Quantity:
BBL Culture Swab (White) [10 swabs]
Price: $0.00 Quantity:
UVE Collection Kits [25/box]
Price: $0.00 Quantity:
VCM Nasal [individual]
Price: $0.00 Quantity:
VCM Lesion [individual]
Price: $0.00 Quantity:
Miscellaneous Supplies
Requisition Order Forms - Veterinarian [1 pad]
Price: $0.00 Quantity:
Requisition Order Forms - Small [1 pad]
Price: $0.00 Quantity:
Requisition Order Forms - Large ( NO carbon copy sheet) [1 pad]
Price: $0.00 Quantity:
Requisition Order Forms - Large ( W/ carbon copy sheet) [1 pad]
Price: $0.00 Quantity:
Specimen Bags [50/roll]
Price: $0.00 Quantity:
Insulated Specimen Transport Bag (for frozen) [1 bag]
Price: $0.00 Quantity:
Biopsy jars [1/each] - Limit of 10
Price: $0.00 Quantity:
Surepath PAP Supplies [25/each]
Price: $0.00 Quantity:
Thinprep PAP Supplies [25/each]
Price: $0.00 Quantity:
Zebra Printer Specimen Labels [1000/roll]
Price: $0.00 Quantity:
Requisition Print Sheet w/ 4 Labels [250/pk]
Price: $0.00 Quantity:
For INL Labs only
Other Supplies/Notes

Client Supply Order Form

Bandage and Phlebotomy Prep

Blood Collection Tubes

Needles and Syringes

Insulin Resistance Testing

Urine Collection

Stool Collection

Culture Swabs

Miscellaneous Supplies