UCLA Pathology Outreach Services

Supply Order Form

Please fill out the supply order form below, print, and fax to our client services department at 1 (310) 267-2685.
Your order will be processed the same business day and shipped out by the following day.
Please call one of our client services representatives if you have any questions.

Client Name: *	A value is required.
Client Number: *	A value is required.
Contact Name: *	A value is required.
Email Address: *	A value is required.Invalid format.
Supplies:
Specimen Bags:	Yes No
Requisitions:
Formalin Supplies:
20 ML (25/box):
40 ML:
60 ML:
90 ML:
Zues:
Swabs:
Other Supplies:

* Indicates required field