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 Quantity
Price: $0.00
Bandage Co-flex 2 inch [36 rolls/case] - Limit of 1 Quantity
Price: $0.00
Bandage Co-flex 1 inch [30 rolls/case] - Limit of 1 Quantity
Price: $0.00
Cotton Balls [500/bag] Quantity
Price: $0.00
Tourniquet [50 pcs] Quantity
Price: $0.00
Needle Holder/Hub [50/pk] Quantity
Price: $0.00
Blood Collection Tubes
Small Purple Top, K2 EDTA 4mL [50/pk] Quantity
Price: $0.00
Large Pink/Purple Top, K2 EDTA 6mL [50/pk] - (ABO/RH and Antibody Testing) Quantity
Price: $0.00
Gold SST 5mL [50/pk] Quantity
Price: $0.00
Gold SST 3.5 mL [25/pk]- (IR's and Pediatric) Quantity
Price: $0.00
Large SST 8.5mL (Tiger) [50/pk] Quantity
Price: $0.00
Red Top, No Additive 6ml [50/pk] Quantity
Price: $0.00
Light Blue Top, Sodium Citrate 2.7 mL [1 each] Quantity
Price: $0.00
Royal Blue Top, K2 EDTA Plasma 6mL (Purple Stripe) [1 each] Quantity
Price: $0.00
Royal Blue Top, K2 EDTA Serum 6mL (Red Stripe) [1 each] Quantity
Price: $0.00
Green Lithium Heparin 6mL (No Gel) [1 each]- (Quantiferons) Quantity
Price: $0.00
Green Lithium Heparin 3.5mL (With Gel) [1 each]- (STAT Chemistry Tests) Quantity
Price: $0.00
Green Sodium Heparin 6mL (No Gel) [1 each]- (Sendout Tests) Quantity
Price: $0.00
Tan, K2 EDTA 3mL [1 each] Quantity
Price: $0.00
Grey Sodium Fluoride Potassium Oxalate 4mL [1 each] Quantity
Price: $0.00
ACD Solution A 8.5mL [1 each] Quantity
Price: $0.00
ACD Solution B 6mL [1 each] Quantity
Price: $0.00
Needles
Needle Blood Collection 21g (Green) [48/box] Quantity
Price: $0.00
Needle Blood Collection 22g (Black) [48/box] Quantity
Price: $0.00
Needle, Butterfly 21g [50/box]- Limit 1 box Quantity
Price: $0.00
Needle, Butterfly 23g [50/box]- Limit 1 box Quantity
Price: $0.00
Needle, Butterfly 25g [10/bag] Quantity
Price: $0.00
Insulin Resistance Testing
Glucose Drink 50g Fruit Punch [6 bottles/pk] Quantity
Price: $0.00
Glucose Drink 50g Lemon Lime [6 bottles/pk] Quantity
Price: $0.00
Glucose Drink 50g Orange [6 bottles/pk] Quantity
Price: $0.00
Glucose Drink 75g Fruit Punch [6 bottles/pk] Quantity
Price: $0.00
Glucose Drink 75g Lemon Lime [6 bottles/pk] Quantity
Price: $0.00
Glucose Drink 75g Orange [6 bottles/pk] Quantity
Price: $0.00
Glucose Drink 100g Fruit Punch [6 bottles/pk] Quantity
Price: $0.00
Glucose Drink 100g Lemon Lime [6 bottles/pk] Quantity
Price: $0.00
Glucose Drink 100g Orange [6 bottles/pk] Quantity
Price: $0.00
Urine Collection
Urine Cups 90 ml [100/pk]- (UA's, Stool, Semen, CT/NG & Trich) Quantity
Price: $0.00
Urine Container 24 Hour Jug [1 bottle] Quantity
Price: $0.00
Urine Specimen Hat [25] Quantity
Price: $0.00
Urine Towelettes [100/box] Quantity
Price: $0.00
Urine Preservative Tube [25/bag] Quantity
Price: $0.00
Stool Collection
Occult Blood Card [1 each] Quantity
Price: $0.00
Swabs
Amies Swab (Blue) [25/pk]- (Group B Strep, Wound/Bacterial, Genital, and Throat cultures) Quantity
Price: $0.00
E-Swab (White) [10 swabs]- (Group B Strep) Quantity
Price: $0.00
BBL Culture Swab (White) [10 swabs]- (MRSA and Strep) Quantity
Price: $0.00
BD Affirm Collection Kit [10/kit]- (Yeast, Trich, Gardenella) NOT PCR Quantity
Price: $0.00
BD Specimen Swab [1 each]- (Throat, Vaginal, and Rectal swabbing for MVP, CT/NG with Trich, and MRSA.) [2 week stability in sleeve.] PCR Quantity
Price: $0.00
Male Urethral Collection Kit [1 each]- (CT/NG [No Trich]) Quantity
Price: $0.00
VCM/UVT Swab [1 each]- (Influenza, RSV, HSV, VZ, Covid) Quantity
Price: $0.00
Aptima Vaginal (Orange) [1 each]- (Mycoplasma genitalium) Quantity
Price: $0.00
Pediatric Supplies
GentleHeel Lancet [1 each] Quantity
Price: $0.00
Pediatric Urine Collector 200mL [1 each] Quantity
Price: $0.00
Purple Microtainer-1mg [1 each] Quantity
Price: $0.00
Red Microtainer (no additive) [1 each] Quantity
Price: $0.00
Miscellaneous Supplies
Custom Printed Requisition with Women's Health Tests Quantity
Price: $0.00
Requisition Order Forms - Veterinarian [1 pad] Quantity
Price: $0.00
Requisition Order Forms - Small (NO Carbon Copy) [1 pad] Quantity
Price: $0.00
Requisition Order Forms - Small (W/ Carbon Copy) [1 pad] Quantity
Price: $0.00
Requisition Order Forms - Large ( NO carbon copy) [1 pad] Quantity
Price: $0.00
Requisition Order Forms - Large ( W/ carbon copy sheet) [1 pad] Quantity
Price: $0.00
Specimen Bags [50/roll] Quantity
Price: $0.00
Biopsy jars [1 each] - Limit of 10 (All biopsy jars must be returned to us.) Quantity
Price: $0.00
Salivette Cortisol Tubes (for Quest test) [1 each] Quantity
Price: $0.00
Surepath PAP Supplies [25/each] (Includes brooms) Quantity
Price: $0.00
Thinprep PAP Supplies [25/each] (Includes brooms) Quantity
Price: $0.00
Zebra Printer Specimen Labels [1000/roll] Quantity
Price: $0.00
Requisition Print Sheet w/4 Labels [250/pk]- For INL Labs Only Quantity
Price: $0.00
Other Supplies/Notes

Client Supply Order Form

Order Form

Bandage and Phlebotomy Prep

Blood Collection Tubes

Needles

Insulin Resistance Testing

Urine Collection

Stool Collection

Swabs

Pediatric Supplies

Miscellaneous Supplies