Supply Order Request

Account Details

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Account NameContact NameContact Phone NumberContact EmailRequested Delivery Date

Kits

Item #

Item Name

Units

Order Qty

Total Qty

CK25

Cold Kit

25/Kit

COVID

Respiratory / Covid-19 Kit

50/Kit

UCK100

Urine Collection Kit

100/Kit

Transport Supplies

Item #

Item Name

Units

Order Qty

Total Qty

3373

Clinical Packs

25/Pack

123

Return Labels

25/Pack

Chemistry

Item #

Item Name

Units

Order Qty

Total Qty

BIOBAG

Biohazard Bags

100/Pack

GRETOP

Green Top (Lithium Heparin)

10/Pack

GRATOP

Grey Top

10/Pack

LAVTOP

Lavender Top

10/Pack

REDTOP

Red Top

10/Pack

TIGTOP

Tiger/Grey & Red Top (SST)

10/Pack

Needles

Item #

Item Name

Units

Order Qty

Total Qty

BN21

Butterfly Needle 21g

10/Pack

BN23

Butterfly Needle 23g

10/Pack

HUBS

Needle Holders (HUBS)

10/Pack

SN21

Straight Needle 21g

10/Pack

TORQTS

Torniquets

10/Pack

Requisitions

Item #

Item Name

Units

Order Qty

Total Qty

CHEMPAP

Chemistry Portal Labeled Paper (4-label)

250/Pack

TOXPAP

Toxicology Portal Labeled Paper (2-label)

100/Pack

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Thank you for ordering from HealthQuest Esoterics!

Please ensure you keep enough supply on hand for delivery turn around:
For courier delivery, please allow 24-48 hours to process your order.
For FedEx shipments, please note shipping can take from 2-7 business days.

Important Notice: Federal and State Law mandates that Clinical Laboratories may give clients only those supplies directly related to the collection of specimens and in amounts proportionate to specimens received from the client.

Account Details

All Account Details Fields are Required

Kits

Transport Supplies

Chemistry

Needles

Requisitions

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