Client Supply Order Form

Current clients may use the form below to request additional supplies. If you are not yet a client, click here to get in touch with us.

Your Name*

Your Facility*

City*

Phone #*

Email Address

Bandage and Phlebotomy Prep

Alcohol Prep Pads [200/box] - Limit of 1Quantity

Bandage Co-flex 2 inch [36 rolls/case] - Limit of 1Quantity

Bandage Co-flex 1 inch [30 rolls/case] - Limit of 1Quantity

Cotton Balls [500/bag]Quantity

Tourniquet [50 pcs]Quantity

Needle Holder/Hub [50/pk]Quantity

Blood Collection Tubes

Small Purple Top, K2 EDTA 4mL [100/pk]Quantity

Large Purple Top, K2 EDTA 6mL [100/pk] - (Hematology)Quantity

Large Pink Top, K2 EDTA 6mL [50/pk] - (ABO/RH and Antibody Testing)Quantity

Gold SST 5mL [100/pk]Quantity

Gold SST 3.5 mL [25/pk]- (IR's and Pediatric)Quantity

Large SST 8.5mL (Tiger) [100/pk]Quantity

Red Top, No Additive 6ml or 10ml [100/pk]Quantity

Light Blue Top, Sodium Citrate 2.7 mL [1 each]Quantity

Royal Blue Top, K2 EDTA Plasma 6mL (Purple Stripe) [1 each]Quantity

Royal Blue Top, K2 EDTA Serum 6mL (Red Stripe) [1 each]Quantity

Green Lithium Heparin 6mL (No Gel) [1 each]- (Quantiferons)Quantity

Green Lithium Heparin 3.5mL (With Gel) [1 each]- (STAT Chemistry Tests)Quantity

Green Sodium Heparin 6mL (No Gel) [1 each]- (Sendout Tests)Quantity

Royal, K2 EDTA 3mL [1 each]Quantity

Grey Sodium Fluoride Potassium Oxalate 4mL [1 each]Quantity

ACD Solution A 8.5mL [1 each]Quantity

ACD Solution B 6mL [1 each]Quantity

Needles

Needle Blood Collection 21g (Green) [48/box]Quantity

Needle Blood Collection 22g (Black) [48/box]Quantity

Needle, Butterfly 21g [50/box]- Limit 1 boxQuantity

Needle, Butterfly 23g [50/box]- Limit 1 boxQuantity

Needle, Butterfly 25g [10/bag]Quantity

Insulin Resistance Testing

Glucose Drink 50g Fruit Punch [6 bottles/pk]Quantity

Glucose Drink 50g Lemon Lime [6 bottles/pk]Quantity

Glucose Drink 50g Orange [6 bottles/pk]Quantity

Glucose Drink 75g Fruit Punch [6 bottles/pk]Quantity

Glucose Drink 75g Lemon Lime [6 bottles/pk]Quantity

Glucose Drink 75g Orange [6 bottles/pk]Quantity

Glucose Drink 100g Fruit Punch [6 bottles/pk]Quantity

Glucose Drink 100g Lemon Lime [6 bottles/pk]Quantity

Glucose Drink 100g Orange [6 bottles/pk]Quantity

Urine Collection

Urine Cups 90 ml [100/pk]- (UA's, Stool, Semen, CT/NG & Trich)Quantity

Urine Container 24 Hour Jug [1 bottle]Quantity

Urine Specimen Hat [25]Quantity

Urine Towelettes [100/box]Quantity

Urine Preservative Tube [each]Quantity

Stool Collection

Occult Blood Card [1 each]Quantity

Swabs

Amies Swab (Blue) [25/pk]- (Group B Strep, Wound/Bacterial, Genital, and Throat cultures)Quantity

E-Swab (White) [10 swabs]- (Group B Strep)Quantity

BBL Culture Swab (White) [10 swabs]- (MRSA and Strep)Quantity

BD Affirm Collection Kit [10/kit]- (Yeast, Trich, Gardenella) NOT PCRQuantity

BD Specimen Swab [1 each]- (Throat, Vaginal, and Rectal swabbing for MVP, CT/NG with Trich, and MRSA.) [2 week stability in sleeve.] PCRQuantity

Male Urethral Collection Kit [1 each]- (CT/NG [No Trich])Quantity

VCM/UVT Swab [1 each]- (Influenza, RSV, HSV, VZ, Covid)Quantity

Aptima Vaginal (Orange) [1 each]- (Mycoplasma genitalium)Quantity

FLOQSwab Self Collection (BD Onclarity HPV testing) [1 each]Quantity

Xpert Swab Specimen Collection Kit (MVP testing) [1 each]Quantity

Pediatric Supplies

GentleHeel Lancet [1 each]Quantity

Pediatric Urine Collector 200mL [1 each]Quantity

Purple Microtainer-1mg [1 each]Quantity

Red Microtainer (no additive) [1 each]Quantity

Miscellaneous Supplies

Custom Printed Requisition with Women's Health TestsQuantity

Requisition Order Forms - Veterinarian [1 pad]Quantity

Requisition Order Forms - Small (NO Carbon Copy) [1 pad]Quantity

Requisition Order Forms - Small (W/ Carbon Copy) [1 pad]Quantity

Requisition Order Forms - Large ( NO carbon copy) [1 pad]Quantity

Requisition Order Forms - Large ( W/ carbon copy sheet) [1 pad]Quantity

Specimen Bags [50/roll]Quantity

Biopsy jars [1 each] - Limit of 10 (All biopsy jars must be returned to us.)Quantity

Salivette Cortisol Tubes (for Quest test) [1 each]Quantity

Surepath PAP Supplies [25/each] (Includes brooms)Quantity

Thinprep PAP Supplies [25/each] (Includes brooms)Quantity

Zebra Printer Specimen Labels [1000/roll]Quantity

Requisition Print Sheet w/4 Labels [250/pk]- For INL Labs OnlyQuantity

Other Supplies/Notes