Ordering Supplies

Please complete the form below to order any materials you may need. Should you have any questions or an item not be listed, please contact Client Services at 415-353-7270.


First time ordering supplies / using our service?
Provider Contact
Provider Name *
Provider Name
Attn:
Attn:
Office Address *
Office Address
Have you moved?
Phone *
Phone
Fax
Fax
Oral Pathology Kits
PLEASE USE THE PROVIDED FIELD TO INDICATE THE QUANTITY NEEDED.
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

  • Biopsy Supplies
    Please use the provided field to indicate the quantity needed.
    Please check this box if your office uses an EMA Interface
    Shipping Supplies
    Other: