Toxicology Supply Request

Please request all supplies by 2 PM CST with a 3-day advance notice.
Allow 2-3 days for shipping

COURIER CLIENTS: Place your supply order one day prior to your pick up date.

Clinic Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone**
Requested Delivery Date*
MM slash DD slash YYYY
Submitted By*
Email*
Products
Collection Cup w/ vacutainer + tubes (no preservatives) (qtys. of 100 or less)
Urine Transfer Straws
Urine Hats
This field is hidden when viewing the form
Oral Swabs (supplied in limited amounts)
This field is hidden when viewing the form
Disinfecting Wipes
Gloves
(one box, indicate: S, M, L, XL)
Glove Size
Printing Materials
Printer Ink (Black)
Printer Ink (Magenta)
Integrated Label Paper (250 sheets per bundle)
Printer Paper
Packing Materials
BioBags
Small FedEx Paks w/ Labels
UPS Paks w/ Labels
This field is hidden when viewing the form
Small FedEx Paks w/ labels
Number of FedEx Paks requested should match number of foil packs
Large FedEx Paks w/ labels
This field is hidden when viewing the form
Small Foil Pack
Small Foil Pack is for 1-10 tubes
This field is hidden when viewing the form
Large Foil Pack
Large Foil Pack for every 25 tubes
Ice Packs
Ice Packs
Please contact supplies@ildp.com with any questions.
Notes
Email
This field is for validation purposes and should be left unchanged.