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Supply Order Form

Fields with an (*) are REQUIRED.

  • Date Format: MM slash DD slash YYYY

  • For Practices with Care Coordinators: If you need Dymo labels or printer ink, please let us know in the special instructions box below (be sure to list print cartridge type).

  • POC (Point of Care) Specimen Cup

    1 pack = 25 cups. Fee will apply.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • Urine Specimen Cup w/Temp Strip

    1 pack = 50 cups.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • Biohazard Shipping Bag with Pouch

    1 pack = 50 bags. Ships only in full pack.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • UPS Shipping Box

    1 pack contains 20 boxes.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • UPS Shipper Labels

    1 pack contains 20 preprinted labels.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • Laboratory Pak

    1 pack contains 20 paks.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • Toxicology Requisition Form

    1 pack contains 25 forms.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • PGx Requisition Form

    1 pack contains 25 forms.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • Optimized Women’s Health Requisition Form

    1 pack contains 25 forms.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • UTI Requisition Form

    1 pack contains 25 forms.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • Buccal Swab
    (For PGx and CGx Collection)

    1 box = 100 swabs.
    Minimum order of 1 box/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • Vaginal Swab
    (Optimized Women’s Health)

    1 box = 10 swabs.
    Minimum order of 1 box/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • Oral Swab (Toxicology Testing)

    1 box = 10 swabs.
    Minimum order of 1 box/Maximum order of 10.
  • Please enter a number from 1 to 10.

  • UTI Collection Kit (Cup and the Tube)

    1 pack = 50 kits.
    Minimum order of 1 pack/Maximum order of 10.
  • Please enter a number from 1 to 10.