Order Supplies Step 1 of 3 33% Clinic / Company InformationClinic / Company Name(Required) Client Number(Required) Type of Clinic(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Full Name(Required) First & Last Name Phone(Required)Email Address(Required) Priority(Required)NormalUrgentMDDrugProMDDrugPro Kit MDDrugPro Req Forms (20) Specimen Cups with Temp Strip (20) False Bottom Tubes & Caps (20) Biohazard Bags (20) MDDrugPro KitPlease enter a number from 1 to 500.MDDrugPro Req Form (EA)PRE 101 Urine Req Form (EA):Please enter a number from 1 to 500.Specimen Cup with Temp Strip (EA)Sterile Cup w/ Temp Strip (EA):Please enter a number from 1 to 500.False Bottom Tube (EA)False Bottom Tube (EA):Please enter a number from 1 to 500.False Bottom Cap (EA)MDDrugPro Oral Fluid Collection Device (EA):Please enter a number from 1 to 500.MDDrugPro Oral Fluid Collection Device (EA)Biohazard Bag (EA):Please enter a number from 1 to 500.MDHeartProMDHeartPro Kit MDHeartPro Req Forms (20) SST Tubes (60) EDTA Tubes (60) False Bottom Tubes & Caps (20) Ice Packs (20) Blood Coolers (20) Biohazard Bags (20) PRE 2017 HEART PROPlease enter a number from 1 to 500.MDHeartPro Req Form (EA)MDHeartPro Req FormPlease enter a number from 1 to 500.SST Tube (EA)SST TubePlease enter a number from 1 to 500.EDTA Tubes (EA)EDTA TubesPlease enter a number from 1 to 500.False Bottom Tube (EA)False Bottom TubePlease enter a number from 1 to 500.False Bottom Cap (EA)False Bottom CapPlease enter a number from 1 to 500.MDWellnessProMDWellnessPro Kit MDWellnessPro Req Forms (20) SST Tubes (20) EDTA Tubes (20) Ice Packs (20) Blood Coolers (20) Biohazard Bags (20) MDWellnessPro KitPlease enter a number from 1 to 500.MDWellnessPro Req Form (EA)MDWellnessPro Req Form (EA)Please enter a number from 1 to 500.SST Tube (EA)SST Tube (EA)Please enter a number from 1 to 500.EDTA Tube (EA)EDTA Tube (EA)Please enter a number from 1 to 500.MDAllergyProMDAllergyPro Kit MDAllergyPro Req Forms (20) SST Tubes (20) Ice Packs (20) Blood Coolers (20) Biohazard Bags (20) MDAllergyPro KitPlease enter a number from 1 to 500.MDAllergyPro Req Form (EA)MDAllergyPro Req FormPlease enter a number from 1 to 500.SST Tube (EA)SST Tube (EA)Please enter a number from 1 to 500.MDGeneticProMDGeneticPro UTI Kit MDGeneticPro UTI Req Forms (20) Urine Cup Free of Preservatives (20) Biohazard Bags (20) UPS Bag (20) MDGeneticPro UTI KitPlease enter a number from 1 to 500.MDGeneticPro STI Kit MDGeneticPro STI Req Forms (20) BD Vacutainer Urine C&S Preservative Cups (20) Biohazard Bags (20) UPS Bag (20) MDGeneticPro STI KitPlease enter a number from 1 to 500.MDGeneticPro PGx Kit MDGeneticPro PGx Req Forms (20) EDTA Tubes (20) Hydraflock Sterile Swabs (40) DNA Stabilizing Solution Vials (20) Biohazard Bags (20) MDGeneticPro PGx KitPlease enter a number from 1 to 500.MDGeneticPro HCV Kit MDDiagnosticPro Req Forms (20) SST Tubes (20) Ice Packs (20) Blood Coolers (20) Biohazard Bags (20) 20 12-050000 DNA Stabilizing solution vialsPlease enter a number from 1 to 500.MDGeneticPro RPP Kit MDGeneticPro RPP Req Forms (20) E Swabs (20) Biohazard Bags (20) UPS Bags (20) MDGeneticPro RPP KitPlease enter a number from 1 to 500.MDGeneticPro COVID, Flu A/B, RSV Kit MDGeneticPro RPP Req Forms (20) NP Swabs with Media (20) Biohazard Bags (20) UPS Bags (20) MDGeneticPro COVID, Flu A/B, RSV KitPlease enter a number from 1 to 500.MDGeneticPro Women’s Health Kit MDGeneticPro Women’s Health Req Forms (20) E Swabs (20) Biohazard Bags (20) UPS Bags (20) MDGeneticPro Women’s Health KitPlease enter a number from 1 to 500.MDGeneticPro RPP Req Form (EA)MDGeneticPro RPP Req FormPlease enter a number from 1 to 500.MDDiagnosticPro Req Form (EA)MDDiagnosticPro Req FormPlease enter a number from 1 to 500.MDGeneticPro CGx Req Form (EA)MDGeneticPro CGx Req FormPlease enter a number from 1 to 500.MDGeneticPro Women’s Health Req Form (EA)MDGeneticPro Women’s Health Req FormPlease enter a number from 1 to 500.Urine Cup Free of Preservatives MDGeneticPro Women’s Health Req FormPlease enter a number from 1 to 500.BD Vacutainer Urine C&S Preservative CupBD Vacutainer Urine C-S Preservative CupPlease enter a number from 1 to 500.EDTA Tube (EA)EDTA Tube (EA)Please enter a number from 1 to 500.Hydraflock Sterile Swab (EA)Hydraflock Sterile Swab (EA)Please enter a number from 1 to 500.DNA Stabilizing Solution Vial (EA)DNA Stabilizing Solution VialPlease enter a number from 1 to 500.E Swab (EA)E Swab (EA)Please enter a number from 1 to 500.NP Swab with Media (EA)NP Swab with Media (EA)Please enter a number from 1 to 500.SST Tube (EA)SST Tube (EA)Please enter a number from 1 to 500.Purflock 6” Swab (EA)Purflock 6” Swab (EA)Please enter a number from 1 to 500.COVID-19 Nasopharyngeal Swab (EA)COVID-19 Nasopharyngeal Swab (EA)Please enter a number from 1 to 500.COVID-19 Nares Swab (EA)COVID-19 Nares SwabPlease enter a number from 1 to 500.MDGeneticPro PGx Req Form (EA)MDGeneticPro PGx Req FormPlease enter a number from 1 to 500.MDDiabeticProMDDiabeticPro Kit MDDiabeticPro Req Forms (20) SST Tubes (20) EDTA Tubes (20) Lithium Heparin Tubes (20) Urine Cups (20) Cherry or Yellow Top UA Preservative Tubes (20) Hydraflock Sterile Swabs (20) DNA Stabilizing Solution Vials (20) Biohazard Bags (20) UPS Bags (20) MDDiabeticPro KitPlease enter a number from 1 to 500.MDDiabeticPro Req Form (EA)MDDiabeticPro Req FormPlease enter a number from 1 to 500.SST Tube (EA)SST Tube (EA)Please enter a number from 1 to 500.EDTA Tube (EA)EDTA Tube (EA)Please enter a number from 1 to 500.Lithium Heparin Tube (EA)Lithium Heparin Tube (EA)Please enter a number from 1 to 500.Urine Cup (EA)Urine Cup (EA)Please enter a number from 1 to 500.Cherry or Yellow Top UA Preservative Tube (EA)Cherry or Yellow Top UA Preservative Tube (EA)Please enter a number from 1 to 500.Hydraflock Sterile Swab (EA)Hydraflock Sterile Swab (EA)Please enter a number from 1 to 500.DNA Stabilizing Solution Vial (EA)DNA Stabilizing Solution Vial (EA)Please enter a number from 1 to 500.Shipping SuppliesSmall Styrofoam Cooler (EA) Small Styrofoam Cooler (EA)Please enter a number from 1 to 500.Medium Styrofoam Cooler (EA)Medium Styrofoam CoolerPlease enter a number from 1 to 500.Large Styrofoam Cooler (EA)Large Styrofoam CoolerPlease enter a number from 1 to 500.Ice Pack (EA)Ice PackPlease enter a number from 1 to 500.Biohazard Bag (EA)Biohazard Bag (EA)Please enter a number from 1 to 500.UPS Overnight Return Shipping Label (EA)UPS Overnight Return Shipping Label (EA)Please enter a number from 1 to 500.UPS Bag (EA)UPS Bag (EA)Please enter a number from 1 to 500.Category B UN3373 Label Sticker (EA)Category B UN3373 Label Sticker (EA)Please enter a number from 1 to 500. Additional Supplies (Please Select 'Yes' or 'No')If you need any additional supplies, please check the box below. Do you need additional supplies?(Required) Yes No After submitting your order, one of our team members will reach out to you with additional support. Thank you for choosing Premier Medical Laboratory Services as your trusted testing partner. Preview Your Order Before Submission{all_fields}CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
