GML Oral Biopsy Kit Order Form

Enter amounts after the items you wish to order and submit electronically.

Client Name:  
Address: Suite, Apt #:
City: State: Zip code:
Contact Name: Phone Number:


         
                

ITEM
AMOUNT
ORAL BIOPSY KIT (includes 1 yellow biohazard bag, 1 formalin vial, 1 protective bubble mailer, 1 UPS air bill, 1 clear UPS air bill pouch, 1 requisition, 1 UPS Laboratory Pak). (EACH) (PKG OF 10)
OTHER:
   

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