Online Supply Order Form
Please allow orders 2-3 business days to process and ship.
Generally, orders received before 12:00 PM CST will begin processing the same day, while orders received after 12:00 PM CST will begin processing on the following business day.
Orders are subject to evaluation and adjustment based on client sample submission volumes.
We encourage clients to order in one-month volumes, and to order roughly one week in advance of running out of supplies.
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SECTION 1: Clinic & Contact Information
Please fill out the following information as accurately as possible. Be sure to include any apartment/suite numbers or any relevant days during which offices may not be open, to ensure that we can get your shipment to you without delays.
Practice/Clinic Name *
Primary Contact Name *
Primary Contact Email Address *
Primary Contact Phone Number
Clinic/Shipping Street Address *
Clinic/Shipping City Name *
Clinic/Shipping State *
Clinic/Shipping Zip Code *
SECTION 2: Test Collection Materials
Please indicate which collection kits you need and which test requisition forms you need. If no collection kits or requisition forms are indicated, none will be shipped.
Which tests do you need specimen collection kits for?
Select any/all that apply. Please note that if you only request test collection kits, but not test requisition forms, for a specific test type, only test collection kits will be shipped. Biohazard bags are shipped alongside all test collection kit orders, no need to request.
Which tests do you need customized test requisition forms for?
We offer customized test requisition forms, pre-populated with clinic name, clinic address, physician name, and NPI number, for your benefit. Select any/all options that apply. Please note that if you only request test requisition forms, but not collection kits, for a specific test type, only test requisition forms will be shipped.
SECTION 3: Shipping Materials
If no shipping materials are indicated, none will be shipped with your order.
Do you need any of the following shipping materials?
Any information left in the comments/notes field will be taken into consideration by our Shipping Manager. Feel free to leave any questions or uncertainties here, in addition to any special requests. While we cannot always honor special requests, it never hurts to ask, and we're more than happy to see what we can do. Thank you!
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