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
  • Equipment

  • # of Laptops Needed
  • # of Printers Needed
  • # of Cartridges Needed
  • List the Exact Model
  • # of Reams Needed
  • 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
  • Genetics

  • # of Cases Needed
  • Hematology (CBC & HbA1C)

  • # 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)
  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed
  • # of Cases Needed
  • Chemistry (CMP, Lipid, Liver, Thyroid)

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

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

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