OncoDiagnostic Laboratory, Inc.

MISSION STATEMENT

CUSTOMER SERVICE

VALUE-ADDED SERVICES

Account Number (existing customers):

Your Name:

A specimen kit provided by OncoDiagnostic Laboratory, Inc. consists of a preprinted test requisition with bar code labels for specimen identification, specimen container (1-16 jars can be specified per tissue kit; 1-8 tubes can be specified per FNA kit), kit box, plastic zip-lock bag, Federal Express Diagnostic Paks, preprinted, prepaid Federal express air-bill.

Fine Needle Aspiration (# of tubes per kit box):	/ # of kits to be shipped:
SurePath ( # of kits to be shipped):
ThinPrep (# of kits to be shipped):
Tissue (# of jars per kit box):	/ # of kits to be shipped:
Tissue (# of jars per kit box):	/ # of kits to be shipped:
Urine Cytology (# of kits to be shipped):

If you want to order individual supplies contained in our specimen kit, please do so below:

GI Test Requisition Quantity:
Prostate Test Requisition Quantity:
Gynecologic Test Requisition Quantity:
General Surgical Test Requisition Quantity:
Urine Cytology Test Requisition Quantity:
Empty Specimen Jar Quantity:
Specimen Jar with OncoFix II Quantity:
Specimen Tube Quantity:
Brush & Spatula Collection Devices Quantity:
Broom Collection Device Quantity:
Pipelle Quantity:
Container Label Quantity:
Kit Box Quantity:
Bio-hazard Bag Quantity:
Federal Express Diagnostic Pak Quantity:
Federal Express Air-bill Quantity:
Bard Needles 441820 (10/box) Quantity:
Bard Needles 441860 (10/box) Quantity:
Bard Needles MN1820 (10/box) Quantity:
FNA Chiba Needles (10/box) Quantity:

Comments or Notes:

Forms
Need a test requisition right away? Just select the type you need below and print it out. Please note, these temporary requisitions will not include bar codes due to duplication issues.
(8.5 x 14 paper recommended for printing)

Urology Test Requisition

GI Test Requisition

Gynecological Test Requisition

General Surgery Test Requisition

Plastic Surgery Test Requisition

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