Fill out the Collection Supply Request Form below. A copy will be automatically sent to Qitek Labs. Collection Supply Request Account InformationAccount Name*Contact Name*Phone*Email* Address*City*State*Zip Code*ShippingBiohazard Specimen Transport Bags (25 per Case)# of Cases NeededUPS Laboratory Pak Bags (10 per Case)# of Cases NeededBarcode Labels (300 Labels, 1 per Case)# of Cases Needed **Note: This item can only be ordered if Qitek Labs supplied a barcode label printer.Barcode Label Printer (1 per Case)# of Cases Needed **Note: This item is only provided by Qitek Labs under special conditions. Georgia Return Labels# of Georgia Return LabelsOklahoma Return Labels# of Oklahoma Return LabelsEquipmentLaptops# of Laptops NeededPrinters# of Printers NeededPrinter Ink Cartridges# of Cartridges NeededPrinter Ink Cartridges TypeList the Exact ModelPaper# of Reams NeededPPE (Only for Qitek Collectors)Small Gloves# of Boxes NeededMedium Gloves# of Boxes NeededLarge Gloves# of Boxes NeededExtra Large Gloves# of Boxes NeededDisinfecting Wipes# of Containers NeededHand Sanitizer# of Bottles NeededToxicologyUrine Cups (25 per Case)# of Cases NeededGeneticsBuccal Swabs (WITH BUFFER LIQUID, 25 per Case)# of Cases NeededHematology (CBC & HbA1C)Lavender Top Tube Kits (25 per Case)# of Cases Needed **Note: Each case includes enough 21G butterfly needles, tube holders, alcohol pads, cohesive bandage, cotton balls, tourniquets, and lavender top tubes for 25 specimens)Lavender Top Tubes (25 per Case)# of Cases Needed21G Butterfly Needles (25 per Case)# of Cases NeededTube Holders (25 per Case)# of Cases NeededAlcohol Pads (25 per Case)# of Cases NeededCohesive Band Rolls (2 per Case)# of Cases NeededCotton Balls (25 per Case)# of Cases NeededTourniquets (25 per Case)# of Cases NeededChemistry (CMP, Lipid, Liver, Thyroid)Tiger Top Tube Kits (25 per Case)# of Cases Needed **Note: Each case includes enough 21G butterfly needles, tube holders, alcohol pads, cohesive bandage, cotton balls, tourniquets, and tiger top tubes for 25 specimens)Tiger Top Tubes (25 per Case)# of Cases Needed21G Butterfly Needles (25 per Case)# of Cases NeededTube Holders (25 per Case)# of Cases NeededAlcohol Pads (25 per Case)# of Cases NeededCohesive Band Rolls (2 per Case)# of Cases NeededCotton Balls (25 per Case)# of Cases NeededTourniquets (25 per Case)# of Cases NeededMolecular Microbiology (RPP, UTI, Wound)Nasopharyngeal Swabs (RPP, 10 per Case)# of Cases NeededCollection Cups with Boric Acid (UTI, 25 per Case)# of Cases NeededCOPAN Transport Tubes (Wound, 10 per Case)# of Cases NeededNotificationsName 1 and Name 2 listed below will be notified with shipment information.Name 1Email 1 Name 2Email 2
