Home Dermatology Laboratory Services Oral Pathology Client Kit Request Close Dermatology Lab Services Department of Lab Services Back to Oral Pathology Kit Request Form Specimen Collection Requirements Search You must have JavaScript enabled to use this form. Clinic Name Contact Name Email Address Phone: Shipping Address Street Address City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Order a Kit A kit includes: 1 FedEx Shipping Bag, 1 FedEx Shipping Label, 1 Specimen Requisition Form, 1 Formalin Bottle (20 mL), and 1 Michel's Medium Specimen Vial, 1 Specimen Bag. Type of Specialty - None -DermatopathologyImmunodermatologyOral Pathology Quantity of Kits - None -241020 Need Additional Supplies? Individual components are available to order below. This can be in addition to complete kits ordered above OR on their own. Formalin bottle size and quanity 7 mL - None -10255075100250500 20 mL - None -10255075100250500 60 mL - None -10255075100250500 120 mL - None -10255075100250500 Michels Medium bottle size and quantity 7 mL - None -10255075100 20 mL - None -10255075100 Specimen Bags - None -2550100150200250300 FedEx Bags - None -510255075100 FedEx Labels - None -510255075100 Are the kits needed by a certain date? No Yes If yes, enter the date here Leave this field blank Requisition Forms Dermatopathology Oral Pathology Immunodermatology
