Request Form For more information on the supplies we offer visit the Oral Pathology page, for Kit Supplies & Shipping. Please request kits at least two weeks in advance. 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: * - Select -24812 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: Leave this field blank