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

Qty
	A5 Bulk Bill Form (2 Part) (No. of Pads)

Qty
	A5 Private Form (1 Part) (No. of Pads)

Qty
	APP A4 Computer Forms

Evacuated Blood Collection
	Gold Cap 8.5 mL Serum Gel
	Mauve Cap 4 mL EDTA
	Pink Cap 6 mL EDTA
	Blue Cap 2.7 mL Citrate
	Grey Cap 2 mL Oxalate
	Needles 21g 1"
	Needles 21g 1.5"
	Needles 22g 1.5"
	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)
	Faecal Human HB Kits
	Paediatric Urine Collectors
	Amies Transwab
	PCR swab (plain sterile)
	Respiratory PCR Swab (VTM)
	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
	Surepath Vials
	ThinPrep Vials
	Vaginal Specula (Screw)
	Small
	Medium
	Large
	Vaginal Specula (Ratchet)
	Small
	Medium

Histopathology
	Buffered Formalin
	25 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: