Immunodermatology Client Kit Request Form

For more information on the supplies we offer visit the Immunodermatology page, for Kit Supplies & Shipping.

Practice Name: ^*

Street Address: ^*

City: ^*

State: ^*

ZIP Code: ^*

Suite/Room #:

Phone: ^*

Fax Number: ^*

Email Address: ^*

Practice Specialty:

Number of Physicians in Practice:

Number of Kits Requested: ^*

Are the kits required by a specific date? (If yes, enter the date. If no, leave blank.):

Special Instructions i.e. no formalin vials needed:

If you have questions or if other support would be helpful, we are please to provide assistance!

The Immunodermatology Laboratory Office is open from 8 am-4:30 pm, Mountain Time, Monday-Friday. We will return all calls and inquiries received after normal business hours the next day.

Local: 801-581-7139
Toll-Free: 866-266-5699
Fax: 801-585-5695
Email: D ermatologyLaboratories@hsc.utah.edu

Shipping Address

Immunodermatology Laboratory
Department of Dermatology
University of Utah Health Care
417 South Wakara Way, Suite 2151
Salt Lake City, Utah 84108

Complimentary courier services are available within carrier ranges and can be arranged by contacting the Immunodermatology Laboratory for scheduling. Where courier service is not available, specimens should be shipped via expedited shipping.