Ordering Supplies

For your convenience, order all the shipping materials you need to send us cases. Please complete the form below.


First time ordering supplies (new provider)?
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.
    Does your office use an EMA Interface?
    Shipping Supplies
    Other: