Fill out the Collection Supply Request Form below. A copy will be automatically sent to Qitek Labs.

Collection Supply Request

  • Account Information

  • Shipping

  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed **Note: This item can only be ordered if Qitek Labs supplied a barcode label printer.
  • # of Cases Needed **Note: This item is only provided by Qitek Labs under special conditions.
  • # of Georgia Return Labels
  • # of Oklahoma Return Labels
  • PPE (Only for Qitek Collectors)

  • # of Boxes Needed
  • # of Boxes Needed
  • # of Boxes Needed
  • # of Boxes Needed
  • # of Containers Needed
  • # of Bottles Needed
  • Toxicology

  • # of Cases Needed
  • # of Cases Needed
  • Pharmacogenomics

  • # of Cases Needed
  • Molecular Microbiology (RPP, Ear, UTI, Wound)

  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed
  • Notifications

    Name 1 and Name 2 listed below will be notified with shipment information.