Ordering Supplies

Please complete the form below to order any materials you may need.

*Note: Any order placed after 1:00 PM PST will be fulfilled on the next business day. Delivery may take up to 5 business days depending on method of transport. We apologize for any inconvenience this may cause, and we thank you for your patience and understanding.

Should you have any questions, are looking for an item not listed below, or have an urgent supply request, please contact Client Services at 415-353-7270.

First time ordering supplies or using our service

Yes

Provider Contact

Provider Name

First Name

Last Name

Degree

Attn

First Name

Last Name

Office Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you moved

Yes

Please fill out if you would like an email confirmation.

Phone

(###)

###

####

Fax

(###)

###

####

Oral Pathology Kits

PLEASE USE THE PROVIDED FIELD TO INDICATE THE QUANTITY NEEDED.

Number of Oral Kits

[Each] For Oral Surgeons, DDS, etc. Each Oral Pathology Kit includes:

1 Requisition Form & Oral Diagram

1 Med 20ml Specimen Container

1 Biohazard Specimen Bag

1 FedEx Clinical Pak & Canister

1 FedEx Pre-Printed Airbill

* Due to limited supply on canisters we are limiting orders to 10 kits to allow quicker turnaround.

Biopsy Supplies

Please use the provided field to indicate the quantity needed.

UCSF Requisition Forms

[each]

EMA Interface Requisition Forms

[pack, 250 = 1 pack]

Physician Address Labels for UCSF Requisition Forms

[sheet, 30 = 1 sheet]

*Please note that if you have multiple providers referring from your location, please list them in the "Other:" field at the bottom of this page.

Small Specimen Container

(7mL) [each]

*Please note that we are currently unable to ship 7ml Specimen Containers outside of California. Please select either 20ml Containers or call us at 415-353-7270. Thank you.

Medium Specimen Container

(20mL) [each]

Large Specimen Container

(60mL) [each]

XLarge Specimen Container

(120mL) [each]

XXLarge Specimen Container

(480mL) [each]

Immunofluorescence Bottles

(DIF) [each, limit 10]
Due to the shorter t_1⁄2 of Michel's Transport Medium, we are limiting orders to ≤10 vials per order. Should you require >10 vials, please contact Client Services at 415-353-7270.

Shipping Supplies

Biohazard Specimen Bags

[each]

White Fold Up Shipping Boxes

[each]

FedEx Clinical Shipping Paks

[each]

FedEx Pre Printed Airbills

[each]

Other

Please indicate below

(Ie. "# Cardboard canisters for Oral Cases"; Physician Label Address Changes; Additional supplies not included above; Notes to our supply team, etc.)

ABOUT
OVERVIEW
FACULTY
EVENTS

SERVICES
OVERVIEW
ORIGINAL DIAGNOSIS
CONSULTATION
IMMUNOFLUORESCENCE
MOLECULAR TESTING
ORAL PATHOLOGY

FOR PROVIDERS
OVERVIEW
SEND CASES
ORDER SUPPLIES
FORMS
INSURANCE INFO
RESULTS PORTAL

EDUCATION
VISITING SCHOLARS
FELLOWSHIPS

FOR PATIENTS
FAQ FOR PATIENTS
PAY A BILL

INTERNAL
LOGIN

The University of California, San Francisco. ©2014 - 2016 The Regents of the University of California
UCSF Dermatopathology and Oral Pathology Service | 1701 Divisadero St. Suite 280 | San Francisco, CA 94115
Phone: (415) 353-7546 Toll Free: (800) 497-0244 Fax: (415) 353-7543
CLIA ID: 05D0669292 CA LAB LIC: CLF00011278

Web design by Dayspring Studio