Online Supply Re-Order Form
*Doctor Name:		*Surgery/Clinic/Hospital:
*Ordered By:		*Address:
*Contact No:		* = Required Fields

Qty
	Bulk Bill Form (2 Part) (No. of Pads)
	Private Form (1 Part) (No. of Pads)

Qty
	APP A4 Laser Forms
	DMC A4 Laser Forms

Evacuated Blood Collection
	Gold Cap 8.5 mL Serum Gel
	Mauve Cap 4 mL EDTA
	Mauve Cap 10 mL EDTA
	Blue Cap 2.7 mL Citrate
	Grey Cap 2 mL Oxalate
	Needles 21g
	Needles 22g
	Holders (Barrels)

Needles and Syringes
	Syringe 5 mL
	Syringe 10 mL
	Syringe 20 mL
	Needles 21g
	Needles 23g

Microbiology
	70 mL Urine jars (yellow cap)
	70 mL Faeces jars (brown cap)
	Paediatric Urine Collectors
	Amies Transwab
	PCR swab (plain sterile) - suitable for viral investigation
	Nasophayngeal swab
	Blood Culture Bottles

24 Hour Urine Container
	Plain
	With Acid (Caution)

Cytology
	Cytology (Pap) Smear Kit (include Glass Slide, Slide Holder, Cytobrush, Cervix Sampler, Spatula)
	Cytobrush
	Cervix Sampler
	Ayre Spatula
	Glass Slides
	Glass Slide Transport Holder
	Spray Fixative
	ThinPrep Vials
	Vaginal Specula Screw
	Small
	Medium
	Large
	Vaginal Specula Ratchet
	Small
	Medium

Histopathology
	Buffered Formalin
	30 mL
	70 mL
	250 mL
	Michels Transport Medium
	Pails (Hospital Only)
	Small
	Medium
	Large
	Punch Biopsy
	2
	3
	4
	5
	6
	8

Misc.
	Specimen Carrier Bags
	Glucose Drink (50 g)
	Glucose Drink (75 g)
	Alcohol Wipes
	Other: