Supply Order Form

Order supplies for your practice. All supply orders are fulfilled by Summit Pathology at no charge to established accounts. Questions? Call us at 970-212-0530.

Note: All fields marked * are required. If you do not know your Client ID, call our main office at 970-212-0530. Enter quantities of zero (or leave blank) for items you do not need.

Practice Information

Office / Practice Name

Client ID Don't know your Client ID? Call 970-212-0530.

Phone

Street Address

Address Line 2

City

State

ZIP Code

Surgical Pathology Supplies

Surgical Pathology Requisitions – 250/Bundle

20ml Tissue Vials (Formalin) – 24/Box

60ml Tissue Vials (Formalin) – 24/Box

90ml Tissue Vials (Formalin) – 24/Box

120ml Tissue Vials (Formalin) – 24/Box

1/2 Gallon Tissue Containers – Each

Prostate Biopsy Kits – Per Box

Urine Cups – Each

Slide Holders – Each

Bone Marrow Kits – Each

Cyto / Molecular Supplies

Pap/Biopsy Requisitions – 250/Package

ThinPrep Bottles – 25/Flat

Cytobrushes & Plastic Spatulas – 25 Each/Bag

Cervical Papettes (brooms) – 25/Bag

Aptima Gen Probe Swabs (purple) – 50/Box

Aptima Gen Probe Swabs (orange) – 50/Box

Aptima Gen Probe Urine Kits (yellow) – 50/Box

BD Affirm VPIII Pathogen Swab Kit – 10/Box

Conventional Slide Pap Kit – Each

BD Universal Viral Transport (Herpes Only) Kit – Each

Non-GYN Supplies

30ml Cytolyt Solution Cups – 50 per Box

30ml Cytolyt Solution Centrifuge Tubes – 20 per Yellow Tray

32 oz. Bottle Cytolyt Solution – Each

50% Alcohol Cups – 50 per Box

Thyroid FNA Kits – Each

General Supplies

Specimen Biohazard Bags (small 6×9) – 100/Bundle

Specimen Biohazard Bags (large 12×16) – Each

Supply Request Forms – 10/Bundle

Specimen Tracking Forms – 250/Bundle

Additional Requests

Message / Special Instructions

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