Supply Order Form

Please allow 3-5 business days for turnaround on all supply requests.

By regulation, the supplies we are sending are only to be used in the collection and submission of samples to Peterson Laboratory Services, P.A. for testing. Please assist us with compliance.

Please enter the quantity of the item requested in the box. i.e. 1 pkg, 4 ea, 2 flats, etc.

Your Name

Client Number (located on requisition)

Company Name (please no abbreviations)

City

Phone #

Transportation Supplies

UPS Shipping Labels

Specimen Transport Bags (100/package)

Shipping Boxes (25/package)

Requisitions / Test Request Forms

(each; specify total #):

PAP / Cytology (yellow)

ABN Forms

Non-Gyn Cytology (green)

Surgical Pathology (pink)

Cytology Supplies

5-Slide Holder, Plastic (each)

2-Slide Holder, Plastic (each)

Glass Slides, (Cytology) 72/box

Cytology Spray Fixative (each)

Medscand Cyto-Brushes and Spatula (25 each/package)

ThinPrep PAP Test Vials (25/flat)

ThinPrep Papette Broom (lt purple handle) (25/package)

ThinPrep CytoLyt Solution FNAs (30 mL solution in 50mL VIAL) (20/flat)

ThinPrep CytoLyt Solution NON-Gyns (30 mL solution in 120 mL container w/ blue lid) (each)

Histology Supplies

RPMI Vial (flow cytometry & cytogenetics)

Biopsy Bottles, W/Formalin (24/Box)

20 ml pre-filled biopsy bottles

40 ml pre-filled biopsy bottles

60 ml pre-filled biopsy bottles

Biopsy Containers (screw top lids empty)

120 ml (non-sterile yellow dot)

240 ml (non-sterile red dot)

500 ml (non-sterile green dot)

1000 ml (non-sterile orange dot)

Biopsy Containers (snap top lids empty)

128 oz

Miscellaneous Supplies

I declare that the info I’ve provided is accurate & complete

Please allow 3 to 5 days turnaround on all supply requests. Thank you.