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Supply Request Form
Blue Mountain Pathology, Inc. is pleased to offer collection supplies at no charge for testing to be performed at our laboratory. Please fill out the form below, supplies are routinely sent out within one day of receipt of the request.
 
An asterix (*) indicates a required field
 
Initial Info
Date (mm/dd/yy)*  
Clinic*  
Email*  
Completed By*  
STAT Delivery  
Cytology
  Sure Path kits (Vials and Brooms)
  Sure Path Brushes
  Sure Path Cervix Brush Combi
  Pap Pack Kits (Conventional)
  Slide Transport Containers
  Urine/Sputum/FNA Containers (with fixative)
  Cytology Pump Spray Fixative
  Slides (Frosted End)
Histology
  Biohazard Bags
  1 ounce Fixative Bottles
  4 ounce Fixative Bottles
Forms/Notices
  Requisitions
  Pap Information stickers-unmarked
  Pap Information stickers w/ auto "Reflex HPV if ASCUS"
  Surgical Bx & Non-Gyn Specimen Request Stickers
  ABN Form
Special Requests
Antispam Question*

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