Supplies Request Form

Please fill the form below and Submit for Supplies

Access the Supplies Request Form for ordering convenience by filling it out online Or Download the form, complete it, and then submit it to us with the subject line “Supplies Request Form” to cs@avanticlab.com.

Client Name

First Name

Middle Name

Last Name

Address

Street Address

Apt, Flat, Floor (Optional)

City

State

Zip/Postal

Client Phone Number

Practice Name

Practice / Organization Specialty

Tubes

SST (Marble top tubes)

Red (Plain Red Tubes)

Lavender (EDTA)

Light Blue (Sodium Citrate)

Grey (Potassium Oxalate)

Green (Sodium Heparin)

Royal Blue (Trace Element K2 EDTA)

Transfer Tubes

Urine Culture and Sensitivity

Needle

21x1” (Box of 100)

22x1” (Box of 100)

22x1 ½” (Box of 100)

22x1 ¼” (Box of 100)

Butterfly Needles

21G ¾” (Box of 50)

23G ¾” (Box of 50)

25G ¾” (Box of 50)

Obgyn

Aptima Swab

M4 Transport Tube

Starswab II

Biopsy Container

Specula

Thin Prep

Miscellaneous

Gloves Small

Gloves Medium

Gloves Large

Gauze 2x2

Gauze 4x4

Alcohol Swab

Bandaid

Needle Holder

Tourniquet

Sharp Containers

24H Urine Containers

Sterile Urine Containers

O & P Containers

Specimen Bags

Others

General Requisition Form

Toxicology Requisition Form

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Please fill the form below and Submit for Supplies

CONTACT US

Let’s Work Together! Book your visit.

For Patients

For Physician

Career/Employee

Important Links

Information

FAQs

Archives

Categories

Please fill the form below and Submit for Supplies

CONTACT US

Let’s Work Together! Book your visit.