CLIENT SERVICES

Client Services Requistion Forms

Please Login to use our Auto-Populate Feature You can login on our Portal Page - Click Here To Return to our Login Form Please Call 303-344-1290 to have a User ID / Password Created

Instructions:  - You must fill out and include with specimens either the PDF or the Online Version of the Requistion Form. - The PDF Version must be printed out, then handwritten. - You may type into the Online Version and then print it out. - When printing the Online form, make sure the Print Margins are set to .25" or less - After completing the Requisition Form, please review and fax it to: 303-344-0789

Dermatopathology PDF Requisition Form: Click Here to Download the PDF Dermatopathology Requisition Form

Dermatopathology Online Requisition Form: Click Here to Open the Online Dermatopathology Requisition Form

Immunofluorescence PDF Requisition Form: Click Here to Download the PDF IF Requisition Form

Immunofluorescence Online Requisition Form: Click Here to Open the Online IF Requisition Form

ELISA Online Requisition Form: Click Here to Open the Online ELISA Requisition Form

Client Services Supply Request Form

Client Services Submittal Form - Enter Your Information and Click Submit to Order Supplies

Start by entering your office information, then choose the supplies which you will need.

Practice Name:
Contact Name:

Street Address:

Suite Number:

City:

State:

Please Select AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip:

Phone Number:

Email:

The following supplies are provided at no cost. Enter the quantity desired in the boxes below. For any item which you do not need, leave the corresponding box blank.

Description Enter Quantity Type Formalin jars   box(es) Labels   sheet(s) Michel's Media (for direct IF)   bottle(s) Padded Mailing Envelopes (25 Per Box)   box(es) Biohazard bags   bundle(s) Zebra Printer Labels and Ribbon film   roll(s)