Pathology Consumables Order Form

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Full Name *

Email Address *

Practice stamp or address

Telephone No.

Test Serum Gel 5ml - Gold (Pack Size 50)

Plain Serum 4ml (red (Pack Size 50)

Plain Serum 4ml (red) (Pack Size 50)

Fluoride/Oxalate 2ml (grey/glucose) (Pack Size 50)

EDTA 3ml (lavender) (Pack Size 50)

Citrate 3.5 ml (blue/coagulation) (Pack Size 50)

3.2ml Urine collection kits (microalbumin) (Pack Size 100)

Vacuette Safety Needles (21g green) (Pack Size 30)

Vacuette Safety Needles (22g black) (Pack Size 30)

Vacuette Holdex (luer-adapter) (Pack Size 100)

Urine - plain universals 30 ml (Pack Size 50)

3.2ml Chemistry urine collection kits including cups (Pack Size 50)

10ml Microbiology urine collection kits including cups (Pack Size 50)

Single liquid swabs (pink top) (Pack Size 50)

Chlamydia/ GC swab for PCR (Pack Size 10)

Male chlamydia container (Pack Size 10)

Faecal pots (Pack Size 10)

Histology pots 60ml & forms (Pack Size 10)

Seminal fluid pots & forms (Pack Size 5)

Dermapaks (skin/nail scrapping packs) (Pack Size 5)

Blood Sciences pathology bags (green) (Pack Size 50)

Microbiology pathology bags (blue) (Pack Size 50)

E- Requesting Carrier Forms & bags (Pack Size 200)

Zebra Printer sample/bag labels (GK420d printer) (Pack Size - 1 Roll)

Zebra Printer sample/bag labels (QLN220mobile printer) (Pack Size - 1 Roll)

Specimen carrier bags (Pack Size 200)

Other, please state:

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