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Supply Form

Office Name:
Account Number:
Address:
Ordered By:

CYTOLOGY SUPPLIES QUANTITY
Conventional Pap Paks
(slide, fixative & collection device included)
Boxes (25 kits/box)
Liquid Based Pap Supplies:
SurePath Collection Vial (Blue Top) Each
ThinPrep Collection Vial (White Top) Each
Specimen Collection Devices:
Cervix Brush (Mop) Each
Cervix Brush (Scored Cytobrush) Each
Plastic Scored Spatula Each
30 ml green top tube with CytoLyt (cytology fixative) Each
30 ml green top tube - Empty Each
CytoLyt (cytology fixative) - Quart Each
TISSUE SUPPLIES  
Formalin Tissue bottles - 20ml Each/Box (32)/Case (256)
Formalin Tissue bottles - 40ml Each/Box (32)/Case (256)
Formalin - Gallon Each
Empty Specimen Containers - 40ml Each
Empty Specimen Containers - 90ml Each
Empty Specimen Containers - 400ml Each
Empty Specimen Containers - Liter Each
Wax Bucket (White) - 1 Gallon Each
Wax Bucket (Blue) - 1/2 Gallon Each
Plastic Bucket - 1 Gallon Each
InCyte Specimen Bag - 6 X 9 Each (100/pack)
InCyte Blank White Labels Each
Specimen Manifest Each (100/pack)
Manifest Bags - Large (12 X 15) Each (50/pack)
Oral Pathology Biopsy Kits
(Tissue bottle, requisition, shipping kit included)
Each
REQUISITION FORMS  
Cytology/Histology Each
Dermatology Slips Each
Oral Pathology Each

We realize that we all work in an ever-changing environment. If there has been a recent change in your office that you would like us to make on your requisition, please note it below.

InCyte Pathology is happy to provide collection supplies at no charge for samples submitted to our laboratory.
Thank you for this opportunity to serve you.

Atlas Labworks